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02/17/2011 19:03 12098389883 BARBAP,A PAGE 02 <br /> �V EHD LOG NUMBER <br /> mg, SAN JOAQUIN COUNTY <br /> -R 22 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ..._ <br /> 600 East Main St. Stockton, CA 95202-3029 a <br /> ENVIRONMENTALHFAIL10tone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: � � 6©� \� P. s'���L BUSINESSIAGENCY: 6/ZOuNp (-Y5 1,r- <br /> ADDRESS: 1-7( 4 V4v CITY/STATE/ZI P: FSCA(o/iz CA <br /> PHONE(1): (764 PHONE (�t(=/ <br /> FACSIMILE:S3� <br /> 7"ENTATIVE•APPOINTMENT DATE- z Time: /o: Dd <br /> (Please allow 10 business days from dato of ap llcatlon submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$122 FEE(G SH CHE ONLY)-REQUEST PROCESSED IN 3 USI SS DAYS <br /> SIGNATURE OF APPLICANT / // DATE z 2z r <br /> Electronic Information: .❑ List❑ Map—Description: <br /> FILE ADDRESS END USE ONLY <br /> Street# Street Name ;'�' Unit 1 <br /> 2.. L3 Unit 2 <br /> 3. <br /> 4, unit 3 <br /> 5. <br /> 6. - Unit 4 <br /> 7. <br /> 8. Unit 6 <br /> L10. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From to <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 /> 9UNOERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> /❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑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 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List un to ton addres 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 to(209)464-0136 or mail to the addresa indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses, contact the EHD. Applications recelved 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 be <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$122 deposit prior to review, <br /> EHD USE ONLY <br /> END 48-06 07!29!10 <br />