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R 'L� MM 1 ' SAN JOAQUIN COUNTY _-O' EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0o 3 0 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Pax:(209)484-0138 Web; www.sigov.org/e <br /> ENVIRONMENT HEALTH (( ((( 2 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> ADDRESS; <br /> BUSINESS/AGENCY: <br /> _ d/;' yyw� �'j� IA5P City/Statelzip �C..� �1� q 7� <br /> PHONE( <br /> 2); <br /> i —•� <br /> T ' 2): FACSIMILE: —�1� — <br /> TENTATIVE"APPOINTMENT PATE: //� lU <br /> (Pleaae allow 10 business days from daW of a li tion submitte— �ly- <br /> pp fir— TantatJve only-must be eonflnnsd) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- E(CASH CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINF55 DAYS <br /> SIGNATURE OF APPLICANT DATE U �O <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street M Street Name city <br /> t. ..Z Q AV0 Unit <br /> tO a W. <br /> Z• v a IT R it rt 5 �C5/.vo ❑ Unit2 <br /> 3• a /t fe fl 1tf t <br /> 4, <br /> K 0 It h It _ ti, OL ,io69-/A10 IDCV -Ln • � <br /> 5. H tt 1t iL l'U', tc I tt \\ <br /> 11 It uyf Z) �,MS,A/0Q/V 1� UnH4 <br /> r 0 It It <br /> it tI u <br /> a <br /> 8. 11 It it ❑ Unit <br /> 3 <br /> 10. II U�i� ❑ Unit <br /> 1. vU S 0- <br /> pacific Date Range of Information Requested: From Z11A W, 5 1 W�-, <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> AeUNDERGROUND TANK(UST)CLEANUP SITE(LOP) COHOUSING ABATEMENT C3 SOLID WASTE FACILITYfVEHICLE / <br /> V OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> I!rUNDERGRCVND TANK(MONRORINcMEMOVAL)V- Ca DOD KENNEL ' ' ' ❑ DAIRY L(J <br /> XHAZARDOUS WASTE GENERATOR,- ❑CHICKEN RANCH <br /> ❑WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑PUMPER T2uCKJYARD(CHEM TOILETS <br /> ❑TATTOo/BODY PIERCING ❑ IjG 4 <br /> ❑MEDICAL WASTE FACILITY PA 13 LAND USE APPLICATION SITES 7 <br /> ❑OTHER pTNER(PLEASE$PECIFY) 8h0� <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYa- <br /> 1. List up to ten addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 4 -0138or mall to the address In above Address <br /> ranges will not be accepted—for additional assistance with foe addresses,contact the EHD. Applications recelved after <br /> 3;00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD filet exist. An appointment for review will be confirmed approximately ten It 0) <br /> days after receipt of application, The flies'will'b'e held for 0 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$105 deposit prior t0 review. <br /> EHD USE ONLY <br /> 05 ' a <br /> " <br /> EHD 46.06 8104/08 <br /> ' PUBLIC RECORDS RELEASE App FORM <br />