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*W\IED SAN JOAQUIN COUNTY EHD LOG NUMBER <br />DEC a 3 2Q10 ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Dain St. Stockton, CA 95202-3029 <br />EjEtpgone: (209) 468-34.20 Fax: (209) 464-0138 Web: www.sjgov.org/ d 03 <br />EN SIT s ICES LIC RECORDS RELEASE APPLICATION I <br />APPLICANT, /. �. _Aarr BUSINESS/AGENCY:1f...k <br />ADDRESS: 2017 1<I! «. ,felt 100 CITYISTATE/ZIP: 9.,Lg Co,claw%, CA 9100 <br />PHONE (1): 916- 2Jq- 74'9 PHONE (2): 'Pit -0q-2059 FACSIMILE: 416-80-600 <br />TENTATIVE` APPOINTMENT DATE; 101164"10 01,r„`ta 4o r , jime; <br />2 r,UJ� (Please allow 10 business days from date of application submittal • *Tentative o ly - must be confirmed) <br />x(19 &HECK BCx TO EXPEorrE REQUEST -$122 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />t' SIG/NA�TURE OF APPLICANT DATE Wo2ho <br />Electronic Information: <br />FILE ADDRESS <br />EMD USE ONLY <br />Unit 7 <br />Sttgot A <br />__ Y Street Namo <br />City <br />C'- <br />0 6® CI unit <br />2 <br />3. <br />nit 3 <br />4. <br />5. <br />© t4 <br />6. <br />r. <br />El Unit S <br />$• <br />8. <br />p Unit 6 <br />10. <br />Specific Dat® Range of Information Requested: From 1/t1ir® ___._____ to i:kl 2003 <br />MENTAL. HEALTH DEPARTMENT' FILES �j <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) [3 HOUSING ABATEMENT F1 SOLID WASTE FACILrTYNEHICLE &_ ri /e5 F r - <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE ' t .1 / f 3 <br />CK, F7117UNDERGROUNDTANK(MRNITOPINGIREMOVAL) ODOG KENNEL ❑ DAIRY VtA <br />Q HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WAvewArERTREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTELJHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />© TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ OTIOR (PLEASE $MCIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 3:00 AM-5:00PW1(EXQLuoiNG HoLwAYS) <br />1. List up to ton addregg2 in the space above. Select the type(s) of flies from the list above by chocking the appropriate <br />box(es). At least one file type MUST be selected. Fdx to (20$)464-0158 Rr 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 EHL? will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ton (10) <br />days after receipt of application. The files will be held for a maximum of five business bays 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 some 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 />68-06 <br />10/T0 39Vd 031NViS OEVOT989TG ZT:9T BTBZ/ZB/ZT <br />