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6 <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Z01jelephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> RONMENTAL HEALTH <br /> PERMMSERVICES PUBLICCAPPLICATION <br /> `g APPLICANT: : [lf( � 1� S`flad(''/of BUSINESS/AGENCY: <br /> ADDRESS: /tate I rs S`/�!`9 L,� G-1�/ CITY/STATE/ZIP: S­Pdc-i I`°N_C� s-21 ra <br /> 6)PHONE (1): 2—o�i''=`�-i� 1 o2 q_ PHONE (2): 9 � ')9 FACSIMILE: <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-$12 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT , DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> W47-E9 1d0 4 �'►�C�i`j�ft� I <br /> 2. Lel L.00r—Oe9 .E j=UrL ❑Unit 2 <br /> 3. { <br /> 6 <br /> 4. ]Unit 3 1 <br /> 5. ***Please respond as soon as possible. <br /> 6. I need to notify applicant during week of 5/14/12 if Unit 4 <br /> 7. EHD has files for listed addresses or not. <br /> 8. ❑ Unit 5, <br /> 9. fr <br /> 10. 1 ❑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 FACILITY[VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) F1 FOOD FACILITY F]WASTE TIRE a <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND 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 up to ten addresses 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 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 /> I - E USE vY <br /> ` d � n � � d ddd <br /> Lo M <br /> -:24E3 60 sm 4N 1 5 <br /> EHD48-06 q-244V CD sb"000 -000 2'5di t ',n `)\A AL <br /> 4ti <br />