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SAN JOAQUIN COUNTY �./ ',G NUMB[=r <br /> 2010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> L� <br /> 600 East Main Si. Stockton, CA 95202.3029 1 <br /> ENVIRuji!'r'IENT HEAUWiphone: (209) 468.3420 Fax: (209)464-0138 Web: www.sjgov.org/eh< 1� <br /> PERMITiSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ) <br /> - t2-K- C�✓ ��`�S/�n�_......_�.__. BUSINESSJAGENCY:_ <br /> ADDRESS -......, - / j�y p / '()„/ Z/CITY/STATE121P: Gr�Icln�ir�rZ4r'SDT <br /> — __......_—. <br /> PHO <br /> NE (1): __ _ --........ PHONE(2). ____ FACSIMILE:TENTATIVE'APPOINTMENTDATf — -- <br /> .. Time <br /> (Plsaso allow 10 fxrab»te days from data of appllcaNe._ ll aubrn TeniaNva-anly-must be conflrmedl <br /> ❑CHECK BOX TO EXPEDITE REQUEST $715 F EE ff; 1 CHEC REOUfST PROCESSEO IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> _..-......._ n"'�_'".-.....-"—� DATE <br /> Electronic Information: ❑ List [I Map- Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Streat s Street Henna - City <br /> t. c9G; e L unit y <br /> cy,�'rAcn1 ,2(x'7/ � �f4r'cjr lnw..� Sfsa � 4ra� <br /> 2. ...041�eGarda �/�' NRS/EIS h-c� .�Rc}[ Ys3a C7 unu x <br /> 3' J�Lc(nk- . 2 2 g.3 Uf"MR`G l7 4� .,S�ac,C'fi�T 9s T1s <br /> 4. �rfRL's Vie- 1r.30� WS 84n4Ne�K tel lec{i<. e4 wv z Elunit 3 <br /> f' / <br /> LrfUPi�/l C wrSf IYTf /!'f7 3 C)/I �}rj/fl lr���y 37W 0Unit/ <br /> 8. <br /> 9. ❑unit s <br /> CI unit <br /> SpsclRc Data Range of Information Requested. From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ---- - - <br /> ❑UNOERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSIRGABATEIrl 1� ❑SOLID WASTE FACILrTYNCHICLE <br /> ❑OfNER CLEANUP SRE(NON•LOP) CgFoon FACILITY-r^7-' viY�rn iiq.c%fSr�WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) U DOG KENNEL H DAiny <br /> ❑HAZARDOLIs WASTE GENERATOR L1 CHICKEN RANCH <br /> PLANT <br /> TIERED PERme TED FACILITY ❑WASTERT ERTRLATAIENT <br /> []MOTE1IHOTEL El PUMPER TNUCN/YAROICHEWMICALAL TOWS <br /> ❑TATTOOIBODY PKRCING []POOLISPA ❑LANO USE APPLICATION SITES <br /> ❑ MEDICAL.WASTE FACILITY [ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY4RIDAY 8:00 AM-8:00pM(EXCLUDING HOLIDAYS) <br /> 1. List uD to tan addresaes in the space above. Select site type(a)of files from the list above by checking the appropriate <br /> box(es). At least ons Ole type MUST be selected. Fall to 12091464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EMD. Applications received after <br /> 3:00 pm wilt be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHO Olen exist. An Appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies will be hold 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 now application may be <br /> submitted when the file Is aystlable. <br /> 4- Any file not returned in the same condition as released will be reorganized by EMD staff at the expense of the applicant <br /> Future file reviews by the some appliCAM may requira a$115 deposit prior to review. <br /> b. If you need funher Assistance, please Conlact Diane Martinez,at(209)466-3425. <br /> .— _ - ENa LrBE ONIY <br /> "a:W___ a>rTw� <br />