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5 <br /> 4, From: 091 ?011 16:55 #451 P.0021002 <br /> d <br /> JEVEFD <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> '50 2 1 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIRONMENTAL HEALTF•feleph ne: (209)468-3420 Fax: (209)464-0138 Web: www,sigov.org/ehd <br /> PERM117SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: V 14� BUSINESS/AGENCY: <br /> ADDRESS: 1�/1 N - COI�� vti C_- CITY/STATE/ZIP: 952� <br /> PHONE(1): �2 °I Q�c( ,. PHONE(2):_C26-9>��3 -0)b9'5 <br /> TENTATIVE*APPOINTMENT DATE. Time: <br /> (Please allow 10 business days from date of application submittal•'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXP DITE REQ - T-$125 FE C S OR CH CK ONLY)-REQUEST PROCESSED IN 3 BUST SS)DAYS <br /> SIGNATURE OF APPLICANT C DATE <br /> 1� f <br /> n� Electronic Information: List❑Map-Description: <br /> l"b FILE ADDRESS <br /> EHD USE ONLY <br /> street# c r- Street Name City, <br /> 1 J l�Unit <br /> 2. <br /> 3, El Unit 2 <br /> 4. — <br /> 5, Unit 3 <br /> 7. Unit 4 <br /> 8. <br /> f <br /> 9. Unit 5 <br /> i <br /> 10. <br /> Specific Date Range of Informati Requested. From Unit e <br /> to <br /> ENVIRONMENTAL HEAL HU ARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEA UP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> I'Rr�rOTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> LTJ UNDERGROUND TANK(MONITORIN /REMOVAL) ❑DOG KENNEL ❑DAIRY P <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT I <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL <br /> El TATTOO/BODY PIERCING El PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 9 COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RE ORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uo to ten addresses in he space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file pe MUST be selected. Fax to(209)454-0138 or mail to the address indicated above Address <br /> ranges will not be accepte -for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed a next business day. <br /> 2. The EHD will notify the app icant if any EHD files exist An appointment for review will be confirmed approximately ten(10) I <br /> days after receipt of applic tion. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled Accor lingly. <br /> 3. A file that is actively being 1 vorked 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 s me applicant may require a$125 deposit prior to review. <br /> A4 kjon <br /> a <br /> EHD 48-OB <br /> 811/t1 } <br />