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<br />SIGNATURE OF APPLICANT
<br />IElectronic Information: Er List p - Description:
<br />FILE ADDRESS
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<br />No. 0027 P. 2 L...G NUMBER
<br />RE-CF1: VED
<br />Aug. 1.3. 2013 4:28PV1
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />SAN JOAQUIN COUNTY
<br />AUG 13 2013
<br />
<br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vvvolv.sjgov.orgfehd
<br />ENVIRONMENTAL HEALTH
<br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION
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<br />EHD USE ONLY
<br />Street # Street Name City LI Unit 1
<br />APPLICANT: Sa(a SI 'C*1-19-1
<br />ADDRESS: 165 0 "fiv5't 53,11,-17 51t -20)
<br />PHONE (1 ):goo) .7 PHONE (2):
<br />CITY/STATE/ZIP: Li* 3r)., etsi 12-
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<br />TE ATIVF' APPOINTMENT DATE: u-es Ph/ Z7 -t=" Time: fo
<br />(Please allow 10 business days from date of appilation su mIttal - • Tentative only - must be confirmed)
<br />CHECK BOX TO EXPEDITE RE ST - $125 (C SH CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS
<br />DATE til.3I13
<br />BUSINESS/AGENCY: 1\11+-ekt 6
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<br />Specific Date 14-anip of Inforrniiiiiih- Requested: From 4.5 64.4 iti 4 0 S pimgage ,(e).- 167.3ek to C 14 t jr-1 r t r '
<br />ENVIRONMENTAL HEACTH DEPARTME T FILES
<br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) MEDICAL WASTE FACILITY OLID WASTE FACILITYNEHICLE
<br />L? 'OTHER CLEANUP SITE (NON-LOP) D HOUSING ABATEMENT 24ASTE TIRE
<br />aryNDERGROUND TANK (MONIT0RINGIRENOVAL) El FOOD FACILITY D pAiRy
<br />IZABOVEGROUND TANK 0 CHICKEN RANCH! DOG KENNEL VIWASTEWATER TREATMENT PLANT
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<br />134IERED PERMITTED FACILITY
<br />AZARDOUSWASTEIHAZARDOUS MATERIALS 0 MOTELIHOTEL
<br />0 POOLISPA
<br />rillUMPERTRUCKIYARD/CNEMICAL TOILETS
<br />LeirtAND USE APPLICATION SITES
<br />D TATTOOIBODY PIERCING El ComPLAINTIREsPONSE RECORDS 111 OTHER (PLEASE SPECIFY)
<br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS)
<br />List up to ten addresses in the space above. Select the type(s) of files from the Ilst above by checking the appropriate
<br />box(es). At least one file type MUST be selected. Fax to (209) 464-0138 gr 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 />The END will notify the applicant if any El-ID 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 clays for review. Appointments
<br />should be scheduled accordingly,
<br />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 fife Is available.
<br />Any file not returned in the same condition as released will be reorganized by END staff at the expense of the . iplioczit.
<br />Future file reviews by the same applicant may require a $125 deposit prior to review.
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