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A r, 9. 2012 2:25 1 M No, 3556 P. 1 <br /> {LATE RECEIVED _ A EHD LOG NUM8LR <br /> SAN JOAQUI <br /> CEI V®®E ENVIRONMENTAL HEALA <br /> �q 600 Fast Main St. Stockton, CA 95202-3029 <br /> I I�, 0 9 2012 Telep one: (209)468-3420 Fax: (209) 464-0138 Web: vvww.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: l Q hloa�:X BUSINESS/AGENCY:. � < <br /> ADDRESS: II^^ I� CITYISTATEIZIP: GA q 33cs <br /> PHONE(1): lk� PHONE(2): FACSIMILE: <br /> TEN TATIVE=AP 0INTMENT DATA; I Time: <br /> (Please allo 10 business days from d8te of application submittal-'Ten(e0ve only-must ba confirmed) <br /> CHECK BOX TO EX EDITE REQ T-$125 FE ( SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 B SIN SS DAYS <br /> SI NAT RE OF APPLI ANT DATE11 <br /> , <br /> Electronic Information: ;9 List[] Map—Description: <br /> FILE ADDRESS EMD USE ONLY <br /> Straet# Street Name City ❑jillit 1 <br /> 1. 1�W 06-!5'/(,f�/7 <br /> PIC f)e-2, <br /> ^ C Unit 2 <br /> / OL �� i A)o ( 1r �3 �� <br /> 4. <br /> UnIE 5 <br /> 6. <br /> Unit 4 <br /> 7, <br /> n': <br /> t <br /> 8. <br /> Unit 5 <br /> 9. <br /> 70. <br /> M Unit 6 <br /> Specific Date Range of Informotio Requested: From to <br /> J <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES1�5 UNDERGROUND TANK(UST)CLEA UP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON•LOP) El FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORIH IREMOVAL)V-J— ❑DOG KENNEL ❑pAIRY ?t <br /> HA7AkODUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA El LAND USE APPLICATION SITES <br /> Ll MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RE ORDS ARE AVAILAELE FOR REVIEW: MONDAY•FRIDAY S:dO AM-5:00PM EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In a space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file ty a MUST be selected. Fax to(209)464-0136 or mall to the address Indicated above. Address <br /> ranges will not be accepted for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:OD pm will be processed t e next business day. <br /> 2. The EHD will notify the appli ant If any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of applica Ion. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accord ngly. <br /> 3. A file that Is actively being rked on by EHD staff may not be Immediately available for review. A new application may be <br /> submitted when the file is a liable. <br /> a. Any file not returned in the s me condltlon as released will be reorganized by EHD staff of the expense of the applicant. <br /> Future fife reviews by the sa a applicant may require a$125 deposit prior to review. <br /> 1 USC ON <br /> 69 ; s ; �� <br /> a <br /> 71z h o , <br /> EHD 48.08 <br /> 81i! 1 <br />