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209-234-0538 Line 1 ' 451:14 11-20-2007 1 H <br /> RMTT2D SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> LL�� ENVIRONMENTAL HEALTH DEPARTMENT <br /> NOV 2 0 2007 600 East Main Street, Stockton,CA 95202-3029 3o ,ENVIRONMENT HEALTH <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgo <br /> PERMIT/SERVIrF PUBLIC RfECORDS RELEASE APPLICATION <br /> APPLICANT: QSaln '(G`� 4Id BUSINESSIAGENCY: /a Od' t // <br /> ADDRESS: / Frdwrk)c,JCSi `//C/e J tJ I��.� mmr���'' g ,/ ✓✓ <br /> PHONE(1):J�—ln-��rr�Jl() PHONE(2): / FACSIMILE:J/-r� J ry• ('f Jr�� <br /> Ao� OJ �1 y-lt <br /> TENTATIVEAPPOINTMENT DATE:�C vY �! Time: <br /> (Please allow 10 business days from date of application submittal•`Tentat/ve only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQUEST•$98.00 FEE(CASH OR CHECK ONL)3-.REQUEST PROCESSED IN 3 BUST ESS DA <br /> YS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Informatio List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 1[ Street 9 Street Name Cily ❑ Unit 1 <br /> A91 Al �lJ) ,a sf- oc]/,to wdh <br /> 2. N V71,On J ' S/'®afC7L r� us)— Unit <br /> 3' III !77©/I �t 2� �� nit3 <br /> 11 a. too© N n f Jr us I� <br /> �( 6• /D O V UA,On � /Y u5r Z <br /> 6. /d. ,nit4 ��) <br /> T• $.90 Ion f r oE5 <br /> ❑ units <br /> 8. 702 1,/110 n UST- <br /> 9. <br /> STs. /r <br /> unit s <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �;'*{ N.�DERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT �4OLID WASTE FACILOYNEHICLE <br /> ,OO HER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY M WASTE TIRE <br /> :Z,UNDERGROUNO TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ri PUMPER TRUCK/YARDICHEM TOILETS <br /> TATTOO/BODY PIERCING El POOLISPAAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> IXA- <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 8:00 AM-5:00PI4 -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 flies 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EH04e46 WEB aaaoor <br />