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05/23/2012 22:03 888480 PEM PAGE 01/01 <br /> SAN JOAQUIN COUNTY / EHD LOG NUMBER <br /> 7FA'-( 9 4 2912 ENVIRONMENTAL HEALTH DEPARTMENT � D�600 East Main St. Stockton, CA 85202-3029 tSt /// o <br /> LFiEAL>ti lephcine: (209)468-3420 Fax: (209)464-0138 Web:www.slgov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> ` v 4APPLICANT: t`�� � wJ BUSINESSIAGENCY: °j 1: <br /> ADDRESS: �Q� y✓^ F. f CQltitrf rs, ��rCITYISTATEIZIP, I <br /> . / <br /> "J6 <br /> PHONE(1)C 7/0 ��Q D PHONE(2): FACSIMILE &� <br /> T TA !VE"APPOINTMENT DATE: <br /> (Please allow 10 business days date of application su i *Tentative only.must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQU i FE 1 R H K LY)-REQUEST PROCESSED IN 3 BllSIN S DA <br /> SIGNATUIRC or APPLICANT — DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USEONLY <br /> Sbuat# Street Hain City <br /> t <br /> 2. Oen <br /> ,V]Unit <br /> s" a Almk]u,ha <br /> 8. ✓ ❑units <br /> s. 5 rn n NO�I Ili 3 ,!Un(,PAI t34,11 <br /> 10. <br /> © nit 6 <br /> EPocRit D2te Range cf Information Roqueetod: Froin 1O <br /> UNDERGROUNnTANK(UST)CLEANUPSITE(Lop <br /> ENVIRONMENTAL 0 SD*ALBTA IMEEPP�RTMENTFILES t Un WASTEFACiLPf'fNetil 7� �� <br /> OTHER CLEANOPSITE(NON-LSP) ❑FOOD FACILITY ❑WASTE TIRE UPI � . <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)N— ®000 KENNEL 1-]DAIRY (z <br /> ATARDOUS WASTE GENERATOR, CHICKEN RANCH ❑WASTEWATERTRE-ATMENT PLANT <br /> TIERED PERMITTED FACILITY MOTrUHDTEL <br /> TATTOOI only PERCING © t,C�],`P NDUrgMPER APPLICATioKS hEc TOILETS <br /> ❑POO1ISFA (LAND USG AppLICATiON SREE <br /> MEDICALWA5IEFANLnY ❑OTHER(PLEASE SPECIFY) <br /> WELL ANp SEPI IC PERMIT REDOROS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. .Mup to ten addressee in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> boxes). At least one file typo MUST be seloetod. EgX to(2091464.0138 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 files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will behold for a maximum of five business days for mviow. Appointments <br /> should be scheduled accordingly. <br /> 3. A Tele 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 fila is available. <br /> 4. Any file not returned in the game condition as released will be reorganized by EHD staff at the expense of the applicant_ <br /> future file reviews by the same applicant may ranulre a$122 deposit prier to review. <br /> cueuse ou�v <br /> ( <br /> rt) . <br /> END4&OF: <br /> o�Izsns <br />