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SNL <br />DATE RECEIVED <br />SAN JOAQUIN COUNTY <br />RECEIVE AIRONMENTAL HEALTH DEPARANT <br />600 East Main St_ Stockton, CA 95202-3029 <br />P 2 7 ZO�Flephone: (209) 468-3420 Fax: (209) 464-0138 Web: www,sigov.org/ehdOT e <br />EHD LOG NUMBER <br />ENVIRONMENTAL HEALTH <br />PERMIT/SER77 <br />VICES //PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT, 4 9" I_q C c a BUSINESSIAGENCY: UK QCaTC �o tYQYtNrG.� Q <br />ADDRESS: 4D LAQ CITYfSTATEMP: LAA c -A cy S 1 -s{ -b <br />PHONE (1): 3o 1 C) 3 S PHONE (2):_ FACSIMILE: 3(01-031r-} <br />TENTATIVE" APPOINTMENT DATE: (d 10 - (j Time: 10 `. (570 <br />(Please allow 10 business days from date of application submittal - •TentWive only - must he co"fivned) <br />❑ CHECK BOX TO EXPEDITE REQUEST - 125 FEE ( H OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT__ -f DATE 4C - 2-`+ "I I <br />Electronic information: O List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />,...Unit f <br />street # <br />etmet Name <br />Gtr1 <br />1. <br />1 1 (a i <br />S• `ia QcL:,,x_ Qtvc. <br />``Cc< <br /><J7c Of -_222- <br />_ iD _ _ ❑ Unit 2 <br />ra`un:t 3 <br />3. <br />($ �"�' $~ <br />S� • '-r&_% s..n v^ A -v c . <br />rY 0. <br />a. <br />6. <br />6a6lit,l <br />f7 (init 6 <br />a. <br />s. <br />101 Unit 6 <br />10. <br />Specific Die Ft2ntj0 of Infaffnati6n Requested: From t0 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES r e <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) [] HOl1SING ABATEMENT ©SOLIi WASTE FACILITYNEHICLE �'^v y� <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACtL" 0 WASTE TME /f/ I I <br />UNOERGROUNO TANK (MONVTGRINGIREYOVAL) V) © DOG KENNEL © DAKIY /o.3-'' <br />HAzARDous WASTE GENERATOR -L-, 0 CHICKEN RANCN 0 WASTEWATER TREATMENT PLANT <br />TIERED PERMDTEO FACILRY91__ 0 MOTELIHOTEL 0 PUMPER TRUCNIYARDICHEIMAL TOILETS <br />TATTOWBODY PIERCL40 ❑ POOLISPA © LAND USE APPLICATION SnEs <br />❑ MEDICAL WASTE FACS.TTY 0 COMPLAMT RECORDS ❑ OTHER (PLEASE SPEC" <br />WELL AND SEPTIC PERMIT RECOMS ARE AYAILAESLE FOR REVIEW: MONDAY -FRIDAY 8:01 AMsv:OOPM (EXCLUDING HOLIDAYS) <br />1. Lis( ug (p tuft 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 satected. Fax to (2M 464-0136 or mall to the address Indicated-aaove. Address <br />ranges will not be accepted -for additional assistance with file addresses, contact the EHD. Applications received after <br />3:DO 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 ties 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 EHDataff may not W 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 m*ased will be reorganized by EHD staff at the expense of the applicant <br />Future file reviews by the same applicant may require a $125 depoelt prior to review. <br />