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04/12/2012 12 :45 FAX Z001/001 <br /> TIL11'ljc'e­u <br /> EHD LOG NUMBER <br /> DATE RECEIVEpSAN .JOA ' <br /> RECEIVE ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C BUSINESS/AGENCY: e A--P-w-cr-1 <br /> ADDRESS: AN6 CITYISTATE/ZIP: KNI ��G � <br /> PHONE (1): �((���0°D-p`L 3`l� PHONE(2): FACSIMILE: <br /> TENtA`T11"VE'APPOINTMENT DATE- ( 201 2 Time: q ty <br /> (Please allow 10 business days from dot of application submittal-'Tonrattve only-muct be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST- 5 FE H OR ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Lf/12-/l 7— <br /> Electronic <br /> f12 17-- <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE:ADDRESS EHD USE ONLY <br /> Street 8 Street Name City 1 <br /> 1. ?S00 u\(_l <br /> -2. S:40 - C �ti R- lA <C - l 1 [3-Unit <br /> 3. 21oov <br /> Unit 3 <br /> r6- <br /> 77. <br /> L �(� S• QAC47o ST' St (�� Unk4 f1 <br /> as NAMN <br /> Unit 5 <br /> 9. <br /> SpfcFflc Date Range of Information Requested: From to _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE$ c,^ kr <br /> UNDERGROUND TAROK(UST)CLFANUP SITE(LOP) ❑HOUSING ABATEMENT RSOLID WASTE FACILIFYNEHICLE C <br /> OTHER CLEANUP SITE(NON-LOP) Ll FOOD FACILITY WASTE TIRE J `�7 <br /> UNDERGROUND TANK MONRORINGIREMOVAL)L ❑DOG KENNEL ❑DAIRY ` , 1 <br /> HAZARDOUS WASTE GENERATOR- ❑CHICKEN RANCH WASTEWATER TREATMENT PLANTL I�` t� <br /> TIERED PERMITTED FACILITY v4- n❑n MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATTOOIBODY PIERCING LJ POOL/SPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•5:OUPM EXCLUDING HOLIDAYS) <br /> 1. List up to ton addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax 209 464-0138 or Mail to the Addre4 WIPve. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may b* <br /> submitted when the file is available. <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 reviews by the same applicant may require a$125 deposit prior to review. <br /> -I ri -1 SFO LY I <br /> 04 -27 5 <br /> I enrt� <br /> Elia 48.06 <br />