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�'1GVC1 V ru <br />JUN 0 7 2011 % F I L E C 0 P ubmit by Erndil Print Form <br />DATE" RECEIVED SAN JOAQUIN COUNTY <br />Con La (ENVIRONMENTAL HEALTHENVIRONMENTAL HEALTH DEPARTMENT <br />Yvette PERMIT/SERVICES <br />direct phony 600 East Main St. Stockton, CA 95202-3029 <br />209-4uµ3421 Telephone: (209) 468-3420 Fax: (209) 4640138 Web: www.sjgov.org/ehd <br />or Cheryl Field <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT:Z2G (� <br />BUSINESSIAGENCY: A F -'-T <br />ADDRESS: Z aC7 ieA.tola CITY/STATE/ZIP: <br />PHONE (1): `l40 (0>V I( PHONE (2): ?V6 -6050 FACSIMILE.��75�, <br />TENrA TIVE* APPOINTMENT D TE; Time: <br />(Please allow to business d from date of application submittal • "reatative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQLi S 15 F (GASH OR CH"CK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE (v -4- Z,2 i <br />Electronic Information: 0 Lis Map - Description:._ �� t C�_� 1"`3 t""=�• p` '' <br />Specific Date Range of Information Requeeted: From <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MOUSING ABATEMENT SOLID WASTE FAGLITYNEHICL� <br />OTHER CLEANUP SITE (NON -LOP) [] FOOD FACILITY WASTE TIRE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL DAIRY <br />HAZARDOUS WASTE GENCRATOR ❑ CHICKEN RANCH WASTEWATER TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY CI MLITCLIHOTEL YJ PUMPER TRUCK/YARD/CHEMiCAL TOILETS <br />TATTOOiBODY PIERCING POOLISPA LAND USE APPLICATION SITES <br />MEDICAL WASTE FACILITY OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-6:00PM (EXCLUDING HoI_IDAYS) <br />1. Llst ua 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 (201464-01311 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 />9:00 pm will be processed the next business day. <br />2. The 6HD will notify the applicant if any EMD files exist. An appointment for review will be confirmed approximately ten (10j <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 $116 deposit prior to review. <br />Is- if you need further assistance, please contact Diane Martinez, at (209) 468.3425. <br />TO/T9 39dd S1Nd1if1SN00 I3d 66099vt9Z6 85:OT TTOZ/!0/90 <br />