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May 15 08 12:25p Paul Humphrey (559 226-3408 P.1 <br /> EHD LOG NUMBER <br /> W MED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT �. g '"�` � <br /> MAY 1 5 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.sjg V.0 <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: eR.w I 1'I i%r ,i) N ___ _BUSINESSIAGE,fNCY: — <br /> ADDRESS: 7yOL � � F A�'on >� P-L_ 'z r1?1_ 4T <br /> FACSIMILE: `7IJ :20L- <br /> PHONE <br /> .�YGIt <br /> PHONE(1):�Y'I^ y��,�—PHONE(2): - / <br /> TENTATIVE"APPOINTMENT DATE Time: <br /> (Please allow ten business days from date of application submittal.'TenraNve only-must be confirmed) <br /> ECK BOX TO EXPEDITE REQUEST.$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DA <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List❑Map-Description: <br /> 77777 <br /> FILE ADDRESS EHD USE ONLY <br /> street IF street Name Cay 171 unit i <br /> 1. 3 5Z 4E. ie,� Dr, 0 1 <br /> 2. Z J�cD %cY» �r wrl �r' H /D&S/vaSP:u o.comp• ylFf n s D <br /> 3. 27.35 Qe L) gY&)/a,4 <br /> / \� <br /> H -r /oEs-Imge.itor& tt9 <br /> nit 4 <br /> 6. <br /> 7. <br /> _ <br /> Unit S <br /> 8. <br /> 9. <br /> nit 6 <br /> 10. <br /> f <br /> Specific Date Range of Information Requested:From "_ to <br /> ENVIRONMENTAL PARTMEtTA.", <br /> A' <br /> tSUNceRGROUNOTANK(UST)CLEANUP SITE(LOPI OHOUSING ATEMENT D WASTE FAd:EH:1CLE:Wt ` I\ <br /> JRCDTHER CLEANUP SrrE itio"OP) OFNK)D FACILITY TE TRE VJ\A <br /> a NDEPGROUND TANK(YONRORNGIREMOvAL) 0DOG KENNEL ❑DAIRY <br /> 2%�NAZARDOUS WASTE GENERATOR 0CHICKEN RANCH =WASTEWATER TREATMENT PLANT <br /> ;RLMERED PERAOTTED FACILrrY 13 MOTEIImom ❑PLIMPER TRUCKIYARDICHEM TOILETS <br /> IM TATTOOBODY PIERCING 17 PODUSPA 0 LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY E3 OTHER(PLEASE SPECIFYI <br /> W ELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW- MONDAY-FRIDAY 8:00 AwS:00Pu-ExCLUC NG HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(20914,4X311or mail to the above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> be processed the next business day. <br /> 2. The EHD will notify the applicant if any END files exist An appointment for review will be confirmed approximately ten <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 the EHD staff may not be immediately available for review. A new application <br /> may be 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> PUaLIC RECORDS RELEASE APP FORM <br /> EHI>4846 1W2Rr7 <br />