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May 15 08 12:25p Paul Humphr& (57c)1226-3408 p.1 EHD LOG NUMBER ID\ U SAN JOAQUIN COUNTY u ll ENVIRONMENTAL HEALTH DEPARTMENT MAY 1 5 2008 600 East Main Street, Stockton, CA 95202-3029 - ?Sr Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wwwAgv.o 5 ENVIRONMENT HEALTH PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION APPLICANT: BUSINESSIAGENCY: ADDRESS: `1 �7 _ l r. ' /P� r zf� FACSIMILE: `CS Z ZL- PHONE (1y: �S 1I 71 �9 & PHONE (2): y� TENTATIVE" APPOINTMENT DATE: Time: (Please allow tan business days from date of application submittal - "Tentative only - must be confirmed) ECK BOX TO EXPEDITE REQUEST -$98.00 FEE (CASH OR C HECK ONLY) -REQUEST PROCESSED IN THREE BUSINESS DA SIGNATURE OF APPLICANT DATE Electronic Information: ❑ List ❑ Map -Description: 10. Specific Date Range of Information Requested: From ENVIRONMENTAL C EHD USE ONLY l� �T /065%-vuSP llo�� ❑ Unit 1 nit 2 G� Ae. 4 ❑ Unit 5 SAnil 6 ARTM E S F CILITY/VEHICLE O t5:UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT LID WASTE A Q OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACI LnY ❑ DAIRY WASTE TIRE O1NDERGROUNDTANK (MONITORING/REMOVAL) 0 DOG KENNEL �Y HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH D PUMPERTRu TREATMENT PLANT ❑ MOTEUHOTEL ED PUMPER TRUCK/YARDICHEM TOILETS TIERED PERMITTED FACILITY O MC>TEUPOOLIPA ❑ LAND USE APPLICATION SITES ❑ TATTOO/BODY PIERCING ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTECPERMIT RECORDS ARE AVAILABLE FOR REMEW - MONDAY-FRIDAYS:00 AM-5:00PM - EXCLUDING HOLIDAYS. 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the above address. Address ranges will not be accepted -for additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by the EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant Future file reviews by the same applicant may require a $98.00 deposit prior to review. oun a ICC r1M1 V FILE ADDRESS Street # Street Name 1. 3 52-' r a. 273-"7- 4. 4 V 5• 7. 8. 9_ 10. Specific Date Range of Information Requested: From ENVIRONMENTAL C EHD USE ONLY l� �T /065%-vuSP llo�� ❑ Unit 1 nit 2 G� Ae. 4 ❑ Unit 5 SAnil 6 ARTM E S F CILITY/VEHICLE O t5:UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT LID WASTE A Q OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACI LnY ❑ DAIRY WASTE TIRE O1NDERGROUNDTANK (MONITORING/REMOVAL) 0 DOG KENNEL �Y HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH D PUMPERTRu TREATMENT PLANT ❑ MOTEUHOTEL ED PUMPER TRUCK/YARDICHEM TOILETS TIERED PERMITTED FACILITY O MC>TEUPOOLIPA ❑ LAND USE APPLICATION SITES ❑ TATTOO/BODY PIERCING ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTECPERMIT RECORDS ARE AVAILABLE FOR REMEW - MONDAY-FRIDAYS:00 AM-5:00PM - EXCLUDING HOLIDAYS. 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the above address. Address ranges will not be accepted -for additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by the EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant Future file reviews by the same applicant may require a $98.00 deposit prior to review. oun a ICC r1M1 V