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Oe f. 14. 2011 10:44AM ANTEA G r-ujp No. 0330 P. 2 <br /> ti DATE RECEIVED 0 <br /> SAN JOAQUIN COUNTY EHD Loc NUMBER <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 500 East Main St. Stockton, CA 95202-3029 <br /> OCT 14 Z011 Telephone: (209)466420 Fax: (209)464.0138 Web:www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Scu'cl 13USINE55/AGENCY:_An�a rrOA, <br /> ADDRESS: 512- yieY[tn Road CITY/STATE/ZIP: 6dn\7-0Ser gS138 <br /> PHONF(1): �Lo PHONE S <br /> FACSIMILE:_ &f) 22.F— 6so(0 <br /> TE'NT'ATIVE`APPOINTMENTDATE: NOICtnkcv 3 esti Time: !o opo <br /> (Please allow 1D business days from date of application submittal-'Tentative only-mustbe confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE (0 <br /> Electronic Information: ❑List[]M —Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9! Street Name qty <br /> 1 f� t 1 <br /> 35 S. hurora r k S c o U5 T OZ 7 <br /> [ ( � 2. 1o8 �. Scotts RYcnKe SincKtvv <br /> �o C <br /> Unit2 <br /> 3- 3 S E• S�otFs Avent�.- 0„ U5 L I <br /> 4. Ly <br /> 8 Unita <br /> Iii .C1(/ 7 -. D4nit 4 <br /> �T 8. <br /> 8 <br /> Units <br /> 10, <br /> Unit 6 <br /> Specific bate Range of mformatlan Requested: From t�Y'�p,y 6 6 � AS ICS AO to -Opfi M r"rY <br /> ,_,/ ENVIRONMENTAL HEALTH DEPARTMENT ILES y� <br /> L'J NDERGROUND TANK(USI)CLEANUP SITE(LOP) Q HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE y1 <br /> (OTHER CLEANUP SITE(NON-LOP) El FOOD FACILITY �' �s�� <br /> ry{�NDERGROUND TANK MONITORING/REMOvAL� ❑DAIRY <br /> E TIRE 1 <br /> ( ) ❑DOG KENNEL - <br /> ��✓✓ AZARDOUS WASTE GENERATDkI� El CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY(� ❑MOTEL/HOTEL <br /> ❑TATTOOIBODY PIERCING ❑PUMP ERE APPLICATION SITES TOILETS <br /> ❑POOI/SPA- Q'CAND USEAPPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(EXCLUDING HOLIDAYS <br /> 1. List ua t ten addresses In the space above. Select the type($)of files from the list above by checking the appropriate <br /> Miles). At least one file type MUST be selected. Fax to(2091464.0130 or mail to the address indicated above Address <br /> ranges will not be accepted-for additional ass lot with file addresses,contact the EHD. Appllcatlons 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 EHb 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 EHb staff at the expense of the applicant. <br /> Future Tile reviews by the same applicant may require a$125 deposit prior to review. <br /> Eaa M ae <br /> anm <br />