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05/23/2012 22: 03 8884443 PEM PAGE 01/01 <br /> ( ' !. EHD LOG NL MEEK <br /> `K ice- I SAN JOAQ,UIN COUNTY <br /> ENVIRONMENTAL HEAL'rH DEPARTMENT <br /> j'��( ?4 7-.01? 6100 East Main St. Stockton, CA 95202-3029 <br /> (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> IENVI��fi6l�iENTZHEALPophone. <br /> P ERNI ITIS E:RVI CES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: � �~— .� I BUSINESSIAGENCY: <br /> ADDRESS, . ` l/�® F . ia�?tl.c ... 1TYISTATEIZiI�: <br /> PHOONE(�) 7/0 5 0 R PHONE(2): FACSIMILE <br /> T TA IVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days dais o{application sq— i *Torrhaflve only,must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE RFQU FE OR H K LY)-R3=QUESTPROCESSED IN a 9llSlN SDA <br /> c IicNATUnr-or APPLICANT — DATES <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADT)RESS EHD USE ONLY <br /> Streelt�# stroot Namo Gay ©unix <br /> 2"_ <br /> 4. nl r`Is s Wilt 3 � <br /> Au <br /> $• _ Units <br /> L <br /> SpocIrte gate Range of Information Roquested. From _ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT PILES <br /> UNDERUF�ttCuNDTANK t(JST)CLEANUPSITE(V)P) ❑HOUS111G4BATENENT XSOLID WASTE FACILiTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ©FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ©000 KENNEL DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CUi eN RANCH Q WASTEIYATERTRF,ATMENT PLANT <br /> TIERLD PERMIrmi)FAo1uTY ®MQTEUHDTEL PUMPER TRUCKIYARDICHEMIGAL TOILETS <br /> TATroo113aDy P ERCING ❑POULiSPA ND Usc ApPLICATMN SITED <br /> MEDICAL lie AM FAOILTTY ©OTHER(PLFASESPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVim (f 0muAy-Fft1DAy 8:00 AM-6,00Pm(ExcLUDIND HOLIDAYS) <br /> 1. List uta to ban addressee in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be&elected. Fax to(208)464-01$e or mail to the address indirA d above._ Address <br /> tangos will not be aicceptod for additional assistance with file addresses,contact.the EHD- Applications r2ceived after <br /> 3:00 plat Will be processeo 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 rae--ipt of application. The files will be held for a maximum of five business days far mvieurr_ Appointments <br /> should be scheduled accordingly, <br /> 3. A file that is ao ively being worked on by EHD staff may net be imm(-diately available for review. A new application may IJe <br /> submitted when the fila is available. <br /> A. Any file not returned in tha same condition as released will be reorganized by EHD staff at the expene of the applicant_ <br /> Future file reviews by the same applicant may require a$422 deposit prior to review. <br /> cuo use ONLY <br /> EHD 4366 07129/70 <br />