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DATED 6660 '°N b Zl0Z 'bb 'unPElm ll P;AIaaaa <br /> RECEIld�i��® SAN JOAQUIN COUNTY <br /> VED ENugRONMENTAL HEALTH DEPARTMENT <br /> r 1868 East Hazelton Avenue, Stockton, CA 95205-6232 J� <br /> JUN 2 a 4ephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org ehd U <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: i9nran SOWIl t <br /> ADDRESS: 2852 SoWnyr (O.At,ton qaad CITY/STATFJZIP: .,j,n Rpv-v%Qv,,.C& ggSS <br /> PHONE(fl: %25 -?$9 -O Z.82 PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT IRATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tenfa6ve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CAS R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTDATE G-22 /2 <br /> Electronic information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EMD USE LY <br /> Street# Street Nance City <br /> Unit 1 <br /> J� 1. 2K EOTracirae <br /> J 2. <br /> Unit 2 <br /> 3. <br /> 4. <br /> nit 3 <br /> OOOOF <br /> 5. <br /> 8' nit 4 <br /> r. -1 e` <br /> 8' Unit 5 <br /> 9. <br /> 10. <br /> Unit 0 <br /> Specific Date Rene of Information Requested: From aft to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT Q SOLID WASTE FACIUEH /� ,� <br /> OTHER CLEANUP SITE(NON-LOP) El FOOD FACILITY ❑WASTE TIRE J 7SICL 1 id-1l IT/2 <br /> , <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) I1 ❑DOG KENNEL ❑DAIRY cd-_-� " -Z-I Z <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> (�TIERED PERMITTED FACIUTY.( ❑MOTEUHOTEL - ❑PUMPER TRUCKIYAADICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING v \ ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-$: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 EEHD 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. <br /> DC Use ONLY <br /> 2q1 su /,: 01, / <br /> -7-'2-(7,-- <br /> 2Jl - / '1 <br /> 3 t� 1 ` '' f• �Iw <br /> EHD 4eLe g/vtq <br /> Tn 7nHr1 bCTC 7nT44rl X7(-44 QF,b T-/)7.-C7F /n:bT 7.TR7./b7/9n <br />