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REQ yfE® `1 EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> AUG 0 12011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> ENVIRONMENTAL HEALTFrelephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:y�W1(1BUSINESSIAGENCY:^ryC6laanT <br /> ADDRESS: 1 V.A)I%W AkI1Aik1IlCTUA CITY/STATE/ZIP: <br /> PHONE (1): =) 7(R( j -2LC)O PHONE(2): (�][tf]�da&LLq6tX FACSIMILE:UL9)IN 01Y <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 buslnas$days from 0010 of eppllcOlioD submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIG A URE OF APPLICANT DATE I <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> f4. <br /> Streat N�a�ma1 ciittLysw� ,^'L Unit 1 <br /> + <br /> Link <br /> B Unit I. <br /> nit 4 <br /> 7. <br /> a. <br /> 9 ❑Unit a <br /> 10. <br /> nk8 <br /> SpeclDc Date Range of Irdorm ijon Requeeted: From to <br /> ENVIRONMENTAL HEA H DEP% MENT FILES G <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT El SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE/(rN�ON-LOQ /A,,r [:1 FOOD FACILITY ❑WASTE TIRE Y� <br /> UNDERGROUND TANK(MONITORING/I-R�EMOVAU yl El DOG KENNEL ❑DAIRY <br /> V i r J <br /> HAZARDOUS WASTE GENERATOR � ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT •3- I <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TATTOOISODY PIERCING ❑POOLISPA ❑LAUI SE APPLICATION SITES <br /> �j MEDICAL WASTEFACIUTY OTHER(PLEASE SPECIFY)d.MY O-V%OLOJU J•t V:, -{>rPTVgjrot M5 MY --rW, <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM(EXCLUDING HOLIDAYS) <br /> 1 In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091484-0198 or all to the address Indica d above Address <br /> ranges will not be accepted-for additional assistance with file addrs!g 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 EHO Ries exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies 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 fife reviews b the same applicant may require a$122 deposit prior to review. <br /> elrouae ONt.v <br /> I <br /> silo sae <br /> olnato <br /> z00/d00 0 ENnTE}ad I83 171[0088LLOLL XVj 9e:E1. Itoz/Lo/80 <br />