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Oct OJ '01 01:20p Diane Prev os 5-594-5763 p.1 <br /> RECOVE U` [-SQ s e F-0 b2 <br /> SAN JOAQUIN COUNTY � EHD LOG NUMBER <br /> DEC 10 2010 ENVIRONMENTAL HEALTH DEPARTMENT U'r IL <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 46&3420 f=ax: (209)464-0138 Web: www.sigov.org/ehd <br /> ENVIRONMENTAL NEA <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Dion ?rC-'_vo61- BUSINESS/AGENCY: Qutl.t �� �c �G <br /> ADDRESS: t`7o2.. E. N1e�/�r- Di�~rv� cirYISTATE/zIP: Tem e Az 852 �� <br /> PHONE(1): (,(D2., 7oO,, 3�LoS PHONE(2): FACSIMILE: <br /> TENTATIVE-APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only.must be confimted) <br /> ❑CHECK BOX TO EXPEDITE RE RUE -S122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE CIF APPLICANT I f f- DATE <br /> c o- � <br /> Electronic Information: Q List❑ Map Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name <br /> City <br /> 1, ❑Unit 1 <br /> h�q 2 La n ce L� UST <br /> 2' C.a u I S e Lan Lct-f-h rz� rt <br /> 3. ❑Unit2 <br /> 4. <br /> S- Q Unit 3 <br /> 8. <br /> 7. Q Unit 4 <br /> 8. <br /> 9, ❑unit s <br /> 10, <br /> Specific Date Range of Information Requested- From to /® --LO— <br /> /� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ❑units <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE h�Cj 1 <br /> C❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVA ❑DOG KENNEL ❑WASTE TIRE <br /> El DAIRY / <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTE LMOTEL N ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOUISPALAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ER(PLEASE SPECIFY) Aicct ❑ <br /> WELL AND SEPTIC PERMrT RECORDS ARE AVAILA LE FO REVIEW: MONDAY-F I Y 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 2119 4tvi-ti138 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 fele 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 tiSE ONLY <br /> 49 f the A <br /> a°. <br /> Q <br /> EHD 48-06 <br /> 07129f10 <br />