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10/20/2011 15'22 FAX 21999G245G URS:GEO-REN 2002/002 <br /> 11-11111111 NUMBER ^ <br /> SAN JOAQUIN COUNTY A <br /> r Z�TI ENVIRONMENTAL HEALTH DEPARTMENT •'� <br /> 600 East Main St. Stockton, CA 95202.3029 <br /> 68-3420 Fax: <br /> 209) <br /> EryVlR�llt�Tls� JCETSPLh PUBLIC4REEORDS(RELEA3IE APPLICATION ATION rg/eha t <br /> 'APPLICANT: lit i5` l/r- C—k-4 -, BUSINESS/AGENCY: I�R� <br /> ADDRESS; 9IS CITYISTATEIZIP: �ci�) q��'1} <br /> PHONE PHONE(2): FACSIMILE: 13-sic,W- 1-`-I sko <br /> TENTATIVE"APPOINTMENT DATE; Time; <br /> (Please allow 10 bualness days from date of application submittal•Tentative Only•must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST•Si FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT. DATE 1 0 121; A l <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> streets Street Name City Unl <br /> .!Il 1: U nit 2 <br /> 3• �rllpll <br /> 4. <br /> D� g• 11311 �IIIIIIIIII <br /> lJnit 4 <br /> 7. <br /> Unita <br /> s. SII IIID <br /> 10, IriI„ Unit e <br /> specific Date Range of information Raquad Pr to <br /> ON I�fN7AL EALTH DEPARTMENT FILES <br /> &�UNOERGROUND TANK(UST) SRE(LOP)"'!111111 (❑❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> IIhII1!,1' <br /> rrr❑r�fO''THER CLEANUP SITE(NON•LOP) J ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITDRINGIREMOVAL)I/- ED DOG KENNEL [3 DAIRY �( <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ZTIERED PERMITTED FACILDY(x ❑MOTELIHOTEL PUMPER TRUCIUYARD/CHEMICAL 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 B:OO AM-6:OOPM(EXCLUDING HOLIDAYS) <br /> 1. Llat un to ten addressee In the apace above. Select the typoe)of fllea from the list above by checking the appropriate <br /> box(ea), At least one file type MUST be selected, FpX t0 1 osl064 0138 or mall to the address ingicated above. Address <br /> ranges will not be accepted•for addltlonal assistance with file addraases, 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 flles will be held for a maximum of five business days for review. Appolntmente <br /> should be scheduled accordingly, <br /> 3. A file that to aotively being worked on by EHD staff may not be Immediately available for review. A new applicatlon 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 4122 deposit prior to review. <br /> a 118E ONLY <br /> 1 � <br /> 071waita <br /> EHD 40-00 <br />