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_2012 2 : 20PM HP LRSERJET FAX P. 1 <br /> I • EHD LOG NUMBER <br /> SAN .JOAQUIN COUNTY /w <br /> MI K05 201? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202.3029 4� <br /> CNVIRONMENTALHEALTT Mphone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd „ <br /> PERM117SERVICES v <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BU SINESSIAGENCY:&g % <br /> ADDRESS: �o SS 12 5 --'p �� CITY/87ATERIP: �a L- A W��C3-7 <br /> FACSIMILE: SfD-RZ� �DqE <br /> PHONE (1); 5 )D^ g��- 901!1 PHONE [2): <br /> TENTATIVE"APPOINTMENT DATE: '5l 1`' l 71me: 7 0 F1 <br /> (Please allow t0 bualnaaa days from date bi application submnal-'rant ilveonty-must be confirm ) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH <br /> OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT_ — DATE 1� <br /> EICCtronlc Information ❑ List 1:1 Map Description; <br /> FILE ADDRESS EHD-USE ONLY <br /> Street# Streat Name City Unit <br /> 1 <br /> In s- V�?, hlodyl" k v2 U`� I 'z) U5 OC S) <br /> Vl/ 2 /U l/f 3 unit s <br /> 3 <br /> Unit 9 <br /> 4 <br /> S. <br /> Unit 4 <br /> 6. <br /> Unit 5 <br /> S. <br /> 9. <br /> ❑ unit e <br /> 10. <br /> to -r <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES SOLID WASTE FACILITYIVEHICLF <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑WASTETIRE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY QPAIRY <br /> ❑ -/ 1 S " <br /> UNDERGROUND TANK(MONITORINOIREMDVAL)O�, ❑ KENNEL <br /> CKEN RA NCH '�yyASTEWATERTREATMEN P 3 7 <br /> HAZARDOUS WAVE GENERAT/O� 0 CHIELIMOTHoTri. ❑PUMPER TRUCKIYARDICHEMICAL TOILET�� <br /> EKED PERMITTED FACILI`rt� ❑POOLISPA LAND USE APPLICATION SITES <br /> TATTOOIBODYPIERCINO OTHER PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY Q COMPLAINT RECORDS ❑ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY S:00 AM-5;OOPM(EXCLUDING HOLIDAYS) <br /> priate <br /> 1, I let u0 to ton addressee In the space above, Select the types) of flies from the�Ie��abe�edroYeo Indira ratad abohockling the varoAddress <br /> box(es). At Isast one fila type MUST be selected. a io i'"'n'4"a' -...,. <br /> ranges wll I not be accepted•for additional assistance with flie addressee,contact the EHD- Applications received atter <br /> 3:00 pm will be processed the next business day. <br /> 2 days fter rrece pt of application.ll notify the applicant IThe files will be held for a maximum of five f any EHO file*exist. An appointment for vusn siew Isi day for be rrev review.med approximately (10) <br /> should be scheduled accordingly. <br /> taff may not be immediately available for review. A new application may be <br /> 3. A file that is actively being worked on by EHD s <br /> submitted when the file Is available. nized by EMD applicant <br /> 4 AnyFutfile ot returned In the Sam$ condition as released il (Ins reviews by the same applicant may requiro a 51125 deposit prlorr to reviewtafl at the expense of the app <br /> NHD USreNAY <br /> eH171 <br />