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09/26/2011 11: 29 510651? ENVIRON PAGE 02/62 <br /> UM <br /> DATE RECEIVED EHD LOG N .. <br /> SAN JOAQUIN COUNTY �-• ', <br /> "Flu ENVIRONMENTAL HEALTH DEPARTMENT � ^I <br /> 201 600 East Main St. Stockton, CA 95202-3029 <br /> SEP Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd 511 ( <br /> ENVPERMIIIS RVICC�TM ENVIRO(VPT'E�FPvi{E^ <br /> 11 / ,WK r PUBLIC RECORDS RELEASE APPLICATION PERMIT - <br /> APPLICANT:'C RkA?IACkAwplz BUSINESSIAGENCY: <br /> ADDRESS: CITY/STATEIZIP: _CkqL (Ptfs <br /> PHONE(1):(,500 4.2(7- 2503 PHONE (2): N�pc FACSIMILE: (,O- 1-7 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Aaka& V\0�C�A( k-6AP1 DATE'g12(12�0 (1 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 2' TY nit2 I� <br /> 3. <br /> 4. <br /> Unit 3 <br /> 6 <br /> 7. <br /> 8. -- <br /> ❑Unit 5 <br /> 9. <br /> 10. 215nd <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E]HOUSING ABATEMENT OLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) F-1 Fool)FACILITYWASTETIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) [I DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANDI ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOoIBODY PIERCING ❑ OOLISPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY XCOMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> boxIles). At least one file type MUST be selected. Fax to(2091464-0138 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 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$125 deposit prior to review. <br /> EHO USF ONLY <br /> EHD 48-06 811/77 <br />