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05/21/2012 00:54 5106559517 ENVIKILIN <br /> ' EHD LOG NUMBER <br /> DATE RECEIVED v SAN JOAQUIN COUNTY <br /> "" wE� ENVIRONMENTAL HEALTH DEPARTMENT <br /> *a�-''$"— 1868 East Hazelton Avenue, Stockton, CA 95205 6232 <br /> ehd <br /> Am " 3 '[012 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgOv.Org/ <br /> EWRoNMENTALHEAI7N PUBLIC RECORDS RELEASE APPLICATION <br /> PE MIT/SERVICES <br /> BUSINESS/AGENCY: <br /> APPLICANT: v15ka /��ro. ENVN <br /> p <br /> DZZOO PQldl��.—�`S`}� �ri CITYISTATEI <br /> ADDRESS: ZIP:FJt1ti <br /> DRE(1): � bb PHONE(2): FAPHONCSIMILE: ISI "U61s � <br /> TENTATIVE*APPOINTMENT DATE: <br /> �r r_.� r�i_ J._Qe �( Time: <br /> (please allow 10 business days from date of application subm al•'Tentative only•must E IN 3 BUSINESS <br /> E K O Y)-REQUES <br /> F-1CHECK BOX TO EXPEDITE REQUEST-$125 E(C O T PROC DATE (j 4•�{ t YS <br /> SIGNATURE OF APPLICANT <br /> Electronic Information: ❑List❑ Map–Descri [on: <br /> EHD USE ONLY <br /> FILE ADDRESS Unit 1 <br /> treat# <br /> / Street Name <br /> cityrVVy'ly''/ SM <br /> 1• f�-f o <br /> 2. <br /> 3' Unit 3 <br /> 4. <br /> Qrp <br /> 5. <br /> nR 4 <br /> 6. <br /> 7. <br /> Unit 5 <br /> 6. <br /> 9. <br /> 10. Unn 6 <br /> Specific Date Range of Information Requested: From - M <br /> ENVIRONMENTALHEALTHDEPARTMENTFILES PLR <br /> 1pWA5fEFACILnYNEIACLEUNBERGROUND TANK(UST)CLEANUP WE(LOP) ❑HOUSING ABATEMENT gTE T12E IoA'.1:Fi-_I( HER CLEAN UP SITE(NON•LOP) ❑FOOD FACILfiY NDERGROUNDTANK(MONRORWGIREMOVAL) ❑DOG KENNEL j$7ACHICKEN RANCH ASTEWATER TREATMENT PLANT <br /> FREp PERMITTED FACILITY ❑MOTELRIOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TJ�TTOOIBOpY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> li�-�' MEDICAL WASTE FACILITY COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAI LE FOR REVIEW: MONDAY-FRIDAY 6:00 AM•5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses to the space above. Select the types)of files from the Ilet above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 12091464-0736 or mall to the address indicated above. Address <br /> ranges will not be accepted•for additional assistance with file addresses,contact the <br /> D. 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 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 His reviews by the same applicant may require a$125 deposit prior to review. <br /> EH <br /> 50 I`Vr <br /> EHD�e-0a 811111 rl/ <br />