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Auo,. 24. 2001 i5:31PM No. 3249 P, 1/i I <br /> 1-5 <br /> � W I irk SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> All Ri ,, `� 2 07 600 East Main Street, Stockton, CA 95202-3029 <br /> ENV�RQCJi��AENT I1EP,�.��fi <br /> Tele w <br /> hone:(209)468-3420 Fax: (209)464-0138 Web: ww.sj30v.or d <br /> PERM ITr",S)ERVICIS I PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: NoI"1 Wen BUSINESS/AGENCY: AFrcEll <br /> ` f <br /> ADDRESS: (p6D Z dwtws Pr. Ste. I� Plea�a4on' CA Ri1579g <br /> PHONE(1): – l� PHONE(2): QZ/S- 22�—`7S'_1 FACSIMILE: <br /> TENTATIVE`AP OINTMENT DATE:—8.13 oA OO–r Time; I' 00 ISM <br /> (Please allow 1 0 business days from dat6 of 0 plication Submittal-7entativo only-must bo confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUE T�5l98.0 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF AiPPLICA T �!�/ DATE 2 2 QO 7 <br /> Electronic Information: List❑ Map–Description: <br /> FIDE ADDRESS EHD USE QNLY <br /> Street 0 Street Name C1 ❑ unit 1 <br /> Z. Unit <br /> U,\ ^ 3. <br /> .h' Ir 4, unit s <br /> v 6. I <br /> /unit 4 <br /> 6. <br /> 7. I <br /> pUnit 6 <br /> 8. <br /> 9. <br /> Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> C9 UNDERGROUND TANK(UST)CLEM UP SITE(LOP) 19 HOUSING ABATEMENT 19SOUD WASTE FACILITYNEHICLE <br /> tH OTHER CLEANUP SITE(NON-LOP) 17 FOOD FACILITY 19 WASTE TIRE <br /> RUNDERGROUND TANK(MONITORIN MOVAL) ❑DOG KENNEL ❑DAIRY <br /> R HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 19 WASTEWATER TREATMENT PLANT <br /> la TIEFED PERmrmo FACILITY ❑MOTEL/HOTELErPUMFIER TRUCK/YARDICNCM TOILETS <br /> TATTOO/BODY PIERCING o POOL/SPA 12 LAND USE APPLICATION SITES <br /> ®MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY/) <br /> WELL AND SEPTIC PERA IT RECORDS ARE AVAILABLE FOR REv1EW -MONDAY-FRIDAY 8:00 AM-6:00PM - EXCLUDINa HOLIDAYS. <br /> 1. List up to ten addresses in he space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file ty MUST be selected. Fax to(209)464-0138 or mall to the address Indicated above. Address <br /> ranges will not b accepted-for additional assistance with file addresses,contact the EHD.Applications received after <br /> 3:00 pm will be p cessed il le next business day. <br /> 2. The EHD will notthe app Icant If any EHD flies exist An appointment for review will be Confirmed approximately ten(10) <br /> days after receipafapplics tion. The files will behold for a maximum of five business days for review. Appointments <br /> should be scheduled accor lingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file Is a oallable. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant <br /> Future file revlewv by the sz me applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> END 4946 WEB 11S2007 <br /> I <br />