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02/17/2011 19:03 12098389883 BARBARA PAGE 02 <br /> IY EHD LOG NUMBER <br /> A SAN JOAQUIN COUNTY <br /> 2 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 p <br /> ENVIRONMENTAL HT-Alff0tone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: � � 6�� P- sr'l14c- BUSINESS/AGENCY: 6�auNp ��i o &%4(-YS �s <br /> ADDRESS: r-7( 4 VAv _ _ CITY/STATE/ZIP: �S C o� � CA <br /> PHONE(1): 7GT $TPHONE (Z); FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE' 0 Time: LO : Dd <br /> (Please allow 10 business days from date of ap Ilcatlon submittal-*Tentative only-mast be confirmed) <br /> ❑ CHECK BOX TC EXPEDITE REQUEST-$122 PEEI&SH CHE ONLY)-REQUEST PROCESSED IN 3 pUSIVSS DAYS <br /> SIGNATURE OF APPLICANT DATE �z <br /> Electronic Information: .[] List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street ft Street Name City Unit 1 <br /> 2. Q unit 2 <br /> 3. <br /> 4. Unit 3 <br /> 5- <br /> 6. Unit 4 <br /> 7. <br /> g, Ultlt b <br /> 9. <br /> 10. Q Unit 6' <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> WUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> *{UNDERGROUND TANK(MONITORINOIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> /❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELMOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOL/SPA ❑LAND UsE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY El OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. LI to ten 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)464-0138 or mail 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 EHD will notify the applicant If any END files exist. An appointment for review will be confirmed approximately ten (10) <br /> days after receipt of applJcation. 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 U.3E ONLY <br /> EHO 48-06 07129110 <br />