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RPR-3-2012 10:42A FROM:GEOPi' c;E ENV 2095690295 -0:4 01 P.2 <br /> � s <br /> D P - ._1VED EHDLOGNUMBER <br /> SAN .lOAQUIN COUNTY <br /> n R 0 3 2012 ENVIRONMENTAL HEALTH DEPARTMENT <br /> TTee��eRh� 600 East Main St. Stockton, CA 95202-3029 W Vii <br /> ENVIRONMENTALHEALI'Hne: (209)468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd <br /> PERMIT/SERVICES <br /> ITtiPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ✓�•7?tl2 /am 440 BUSINESS/AGENCY o 'qt_ �y <br /> ADDRESS: g37 Aje1fP'-14'4 CITY/STATE/ZIP: 1-70'4v"' <br /> PHONE(1): ��q 0.293 PHONE( FACSIMILE: (-)q-,5(, <br /> TENTATIVE'APPOINTMENT DATE: h/ � Time: <br /> (Please allow 10 business days from dTappllcatlon submittal•-Tentaflve only•must be confirmed) <br /> I-SiCHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Ate% E'�`y`�� DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 Street NameClty nl <br /> I�] <br /> 2. -13'39'3 5 Sc r����� �r '� GX - <br /> DV L. 3 C?C� n � � nt U �5 y <br /> 4. sin _ YcL. INS <br /> 6 554 <br /> _ - - - <br /> 6• Nta <br /> 7. <br /> 8. <br /> Unit 6 <br /> 9. <br /> 10. ❑unit6 <br /> Specific Data Range of Information Requested: From to <br /> ,,���/ ENVIRONMENTAL HEALTH DEPARTMENT FILES {/..rI GGNrV <br /> Xl UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICL �I r�p <br /> �I�T HSR CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTETIRE J/,_il3 <br /> �DERGROUND TANK(MONITORINGIREMOVAL)�' ❑DOG KENNEL ❑DAIRY Wil 1 <br /> 16 <br /> ,RRAZARDOUS WASTE GENERATOR O( ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT L4—q-iZ- <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKNARDICHEMICAL 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-5:001`1111(EXCLUDING HOLIDAYS) <br /> 7. List up to ten addresses In the space above. Select the type(s)of riles from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 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 flies 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 EMD 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$122 deposit prior to review. <br /> EHD USE ONLY <br /> IS <br /> -5 z r r e r r <br /> o` <br /> END 4848 ct to& of 0lvpjolj * 6000.;lbzrh 671u,`s,�n ��Yslob� �i'Sy�( s 07, <br />