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D TE RECEIVED EHD LOG NUMBER <br /> ��/'a�I�pE® SAN JOAQUIN COUNTY <br /> V V EAONMENTAL HEALTH DEPART hI NT <br /> I. I 0 0 2012 1868 East Hazelton Avenue, Stockton, CA 95205-6232 \ <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTALHEALTI6 PUBLIC RECORDS ASE ATI <br /> PERMIT/SERVICES <br /> APPLICANT: C--eVO —74A-6 6_.("'Ia BUSINESS/AGE Y: <br /> ADDRESSrz:;>p'�Ob /��/U�2' G 6 —CITY/STATE/ZIP: <br /> PHONE (1): Y7��Z1 y PHON (2 : FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from to ly-application submittal-'Tentative onmust be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINIESS DAYS <br /> SIGNATURE OF APPLICANT DATE Y Iz, <br /> Electronic Information: ❑ List❑ Ma description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 4nit1 <br /> o <br /> UY <br /> 2• ❑ Unit 2 <br /> 3. <br /> 4. Unit 3 <br /> 5• Unit 4 <br /> 7. <br /> 8. ❑ Unit 5 <br /> 9. <br /> 10. ❑ unit s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES / <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILI NEHICiE ,J <br /> OTHER CLEANUP SITE(NON-LOP) F1 HOUSING ABATEMENT ❑WASTE TIRE "7 5,�PS10113 <br /> NDERGROUND TANK(MONITORINGIREMOVALVC. FOOD FACILITY El DAIRY `COYA P I `,4Z` Z_ <br /> ABOVEGROUND TANK CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> AZARDOUS WASTEIHAZARDOuS MATERIALSIX, ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or 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 /> 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 file reviews by the same applicant may require a$125 deposit prior to review. - T30XED AREA'.'EHE U—S-E RLV <br /> to 17� <br /> D Records�ovtded b Staff PP 4Com Tete. staff Name: <br /> EHD 48-e6 W4112 <br />