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DAT CEIVED 6EEO "N Ads, ZIOZ 'til 'urrElamil paniaaaa <br /> SAN JOAQUIN COUNTY <br /> RECEIVE® ENVIRONMENTAL HEALTH DEPARTMENT <br /> r 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> JUN 2 J z <br /> %j�hone: (209)4f,8-3420_Fax: (209)464-01_38 Web:_wwwsjgovorg_ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMITISEHVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT! Mart I{p�, _ BUSINESWAGENCY: &n Sohsen <br /> ADDRESS: 2866 %Ila,tyr reNLlon Rood CITY/STATE/ZIP: ,^ —RAYKon <br /> PHONE(1): nG--7Sq -0Z a PHONE(2): FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only--must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST'-$125 FEE(CAS R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE(,.22.-/Z <br /> Electronic Information: ❑ Llst❑ Map—Description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Streets Street Name City Unit <br /> ra / e- <br /> 2. <br /> S. Unit 2 <br /> 4 <br /> nit 3 <br /> 8. <br /> —, units <br /> 9. <br /> 1 D. <br /> ❑Unit 6 <br /> Speclflo Date Ran®e of Information Requested: From �// to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT Q SOLID WASTE FAciUTY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINOIREMOyAL) ❑DOG KENNEL ❑DAtRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH Q WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEUHOTEL - ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> TArToofflooy PIERCING []POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY []COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AIJAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten 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 (208)464 0138 or mail to the add!Mss indlcated above Address <br /> ranges will not be accepted-for additional assistancewith fila addresses,contact the EMD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any,EMD 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 be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condVtion as released will be reorganized by EMD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a $125 deposit prior to review. <br /> L0l7 Use ONLY <br /> EHD 4840 <br /> B!1/11 <br /> T!] 7ClNJ bCTC T1TJJn Y7rr7J CCbT-117-C7C. /Q'hT 7Tn7 /b7/QM <br />