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DATE ° EHD LOG NUMBER <br /> N SAN JOAQUIN COUNTY <br /> OCT 24 2011 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIRONInEN AZIA?R�: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PERMITISER'4I0ESPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Cory ' `gr f: BUSINESS/AGENCY: E„ut4b, St ,ccs c <br /> ADDRESS: � 43N CITY/STATE/ZIP: ..IAe rA c'7e C'A 95e:z.l <br /> PHONE (1): 21A q'F0- Z; a!2 PHONE (2): FACSIMILE: f y 3 <br /> TENTATIVE`APPOINTMENT DATE. Y,"roll Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only•must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQ EST-$Y2 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE /&�.x V-I l <br /> Electronic Information: ❑ List Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street M Street Name City 1 <br /> i. 3S5pa }�In) 1 or o �,__ UES, 1 1 <br /> 2. -6 TRJ5f0� Unit <br /> � <br /> 4. .� Hoy lJ u 1.0 S Unit 3 <br /> 6• "❑Unit 4 <br /> 7. <br /> S- <br /> 173 Un s <br /> 9. <br /> 10. ❑Unit <br /> Specific Date Range of Information Requested: From to I <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> J�qUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILIfYNENK:LE 111 <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)- ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATORd` ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTo01BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICALWASTEFACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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)4614-P138 or mall to the address Indicated above. Address <br /> ranges will not be accepted-for additional assistanco with file addresses,contact the EHD. Applications recelved after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will nottfy the applicant If any EHD files exist. An appointment for review will be confirmed approximately tan (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$122 deposit prior to review. <br /> Eno USE ONLY <br /> D <br /> 14. LQi2j dilk 1/71 <br /> UJ 3 <br /> EMO 4e-06 0712ene <br /> 100/100f�J XVj Llll LIOZ/bZ/Ol <br />