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nraucivcu <br /> to <br /> JUN 0 7 2011bmitbyEmall Print Form <br /> 0 <br /> DATE RECENED SAN ,JOAQUIN COUNTY <br /> ContatffNVIRONMENTALREAL <br /> Yvette PERMIT/SERVICES ENVIRONMENTAL HEALTH DEPARTMENT <br /> Yvette <br /> phone 600 East Main St. Stockton, CA 95202-3029 <br /> direct harle Telephone: (209)468-3420 Fax: (209)4640138 Web:www.sjgov.org/ehd <br /> or Cheryl Field PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ° rZ2 d( 5 1� BUSINESSIAGENCY: A ES <br /> ADDRESS: 2 OO Iub�o CITYISTATEIZIP: w' I�r C✓fie /GA)--i <br /> PHONE (1): 63Zf)-,`{li,- Oeg t _ PHONE(2):qa 5-9y/o -60C�a FACSIMILE: <br /> TENTATIVE"APPOINTMENT D TE: Time: <br /> (Please allow 10 business d from date of application submittal-'rarrtatNe only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQ4 S - 1B F (CASH OR OHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE (a L� I 2:5 ( <br /> Electronle information: Lis Map-Description:,- Q Ole- cow 01: o� <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city UnIt1 <br /> [4. <br /> .Ci SCJgCW C.(9 /u°` Unit2 <br /> g f� off. fonit 3 <br /> Unit 4 Unit$ <br /> unit 6 <br /> Specific Date Range of Infonnetion Requested: From t0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) [71 DOG KENNEL Fj DAIRY <br /> HAZARDOUS WASTE GENERATOR [:3 CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPR LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REvIEw: MONDAY-FRIDAY 8:00 Am4:00PM(EXCLUDING HOLIDAYS) <br /> 1. Llst uo to ten addresses in the space above, Select the type(s)of Was from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464.0138 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 /> 3:00 pm will be processed the next business day. <br /> 2. The EMD will notify the applicant if any EMD Nle$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 Nle 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 conditionmay require a ill be reorganed <br /> deposit prig foyreHewtaff at the expense of the applicant. <br /> Future Nle reviews by the same applicant <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)466.3425. <br /> EMO Vag ONLY <br /> 91341°9 <br /> END 48.09 <br /> T9/TO 39Vd SINVi-inSNDO I3V 66099VLSZS 69:01 11OZ/L0/90 <br />