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_DATF6�60 'IN bew• :6 6[06 'bb 'Un PFI;Wll_paAla3a8 <br /> RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT t <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-623j <br /> JUN 2 J 2{aephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Poec, "if _ BUSINESS/AGENCY: E4� Safu�i on t <br /> ADDRESS: Z86L $ollin•er ('emtjon Road CITY/STATE/ZIP: 4z,„ �prY o 1 rC[� gySg ; <br /> PHONE(1): 92.5 --789 -02.8Z PHONE(2): FACSIMILE: <br /> TENTA TI VE'AP PO I NTM ENI-DATE: Time: <br /> (Please allow 10 business days from data of application submittal-'Tentative only-must be confirmed) <br /> [--] CHECK PDX TO EXPEDITE REQUES-a'-9125 FEE(CAS R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTDATE 6-22-('Z <br /> Electronic Information: ❑ List ❑ Nlap- Description: <br /> FILE ADDRESS EHD USE LY <br /> Street 4 Street kame city Unit 1 <br /> e R <br /> 2. _ 1771 Unit 2 <br /> 3. <br /> 4. — <br /> nit 3 <br /> 5. <br /> 6, <br /> nit 4 <br /> T. <br /> 8. <br /> Unit 5 <br /> 9. <br /> 10. — <br /> ❑Unit 8 <br /> Specific Date Range of Information Requested From G(/ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIUEHICLTH <br /> OTHER CLEANUP SITE(NON.LOP) ❑FOOD FACILITY ❑WASTE TIRE 1 m7 S <br /> UNDERGROUND TANK(MONITOHINGIREMOvAL) A_ [I DOG KENNEL ❑DAIRY C/J-? - -Z-IZ <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH I--]WASTEWATER TRE�TMENT PLANT <br /> TIERED PERMITTED FACIUT� ❑MOTEUHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> TATTOO/BODY PIERCING ❑PODUSPA ❑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-S:OOPM(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)404-0138 or mail to the address indicated shove. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3;OD pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any,EAD 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 fila not returned in the same cond[ticn 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 /> ewe Usp ONLY <br /> Zq_I . -S , <br /> -7—_2—( Z- GiCA <br /> 3 ^� �� 1 <br /> EHD ease w <br /> Tn 7s1H,A bCTC -'1Ta-4r1 X-4rT-44 CF.trT-1/7-C71Z, /A:trT 7TA7/V7/qA <br />