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0-t. 14 2011 10:44AM A GI'ollp No. 0330 P. 2 <br /> 41 EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> RECCEIVE600 East Main St. Stockton, CA 95202-3029 <br /> OCT 14 2011 Telephone: (209)468-3420 Fax; (209) 464.0136 Web;www.sigov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Sa O, s1C1�(P �1 BUSINESS/AGENCY; An+eel GrOvl� <br /> ADDRESS: 3 2 YC d CITY/STATE/ZIP:_:5d--L Q oSc , CA `t 138 <br /> PHONE(1); (`fob) S 24-fg 77 PHONE(2): FACSIMILE; (4OM1 2 <br /> TENTATIVE`APP0INTMENTDATE: NPluntuy �f � oft Time: 10:00a" <br /> (Ptease atlow 10 business days from date of application submittal•'ienfa0ve only-mus be confirmed) <br /> ❑CHECK SOX TO EXPEDITE REQUEST-$125 FEE CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE I o /r I <br /> Electronic Information: ❑ List❑M -Description: <br /> FILE ADDRESS EHD USE ONLY <br /> StraetM Stmat Name city Unit1 <br /> 1. ro3s S, huroya r + S r- o- 2 511 24( 0 <br /> 2- QOg 6. scoffs hVanKQ stag-trm f�1F�F -� u'u <br /> 3. 35- E• Scotts Av�nL� S o^ 2�I��7iN5� � �� <br /> 4 - Unit3 <br /> 5. <br /> 6. vIdl <br /> nI14 <br /> 7, <br /> $ <br /> Unit 6 <br /> 9, <br /> 10. nit 6 <br /> Spoclftc Dale Range of information Raquasted: Ffom to otfi lLB r"I( <br /> ENVIRONMENTAL HEALTH DEPARTMENTTILES Pf WASTE FACILITYNENICLE <br /> NDERGROUND TANK(US11 CLEANUP SITE(LOP) ❑HOUSING ABATEMENT []WASTE <br /> SOLID THER CLEANUP SITE ❑FOOD FACILITY ❑WASTE TIRE <br /> � <br /> MU ❑ <br /> NDERGROUND TANK(MONrIORINGIREMOVAL) El DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> ERED PERMITTED FACILITY ❑MOTEVHOTELr[-]y1PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBObY PIERCING ❑POgUSPA L7 AND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY•FRIDAY 8:00 AM•5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List no to ten addresses in the space above. Select the type(s)of files from the Ilst above by checking the appropriate <br /> bOx(es). At least one file type MUST be selected. Fax to 209 1464-0136 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with Elie addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD flies 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 expanse of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> EHD USE ONLY <br /> B11fH <br /> Eae AB aB <br />