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� rrrT����Froow MMaa ffrll ��Tc111u�7sIII���H . Bole & Associ 's 530 +633+ 0119 12 / 0 '009 16 : 12 # 140 P . 001 <br /> u u � Vtl�d1A1eN ED EHD LOG NUMBER <br /> w ��"�J'�'Ur SAN .IOAQUIN COUNTY <br /> ": � 0 7 2009 ENVIRONMENTAL HEALTH DEPARTMENT h <br /> Tr 600 East Main Street, Stockton , CA 95202-3029 U <br /> ENVIRONMLNTHEALTFflephone: (209 ) 468-3420 Fax: (209) 464-0138 Web: WWW.Sjgov.o <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: . vv ' n�l'. BUSINESSIAGENCY: aa. ,i5ciZZ <br /> ADDRESS: 160 ,11lyroc & art" ''L City/State/Zip hXf ez T///ff:k / <br /> PHONE (t ): .53C - 63-- - CJ / / 7 PHONE (2): , : : O - cZIS— I!c Ouw Id FACSIMILE: '7,�o17 <br /> TENTATIVE" APPOINTMENT DATE: � �/ 7 /H✓r^t Time: 9.3 (7 _ <br /> (Please allow 10 business days from da a of appltcatton submittal . 'Tentative only - must be confirmed) <br /> ❑ CHECK 13OXTO EXPEDITE REQUEST - $105 FEE (CRASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT r� J DATE ��7 �Z <br /> Electronic Information: ❑ List ❑ Map - Description: <br /> FILE ADDRESS EHD _USE ONLY <br /> Unit1 <br /> Street # Street Name <br /> o Clty <br /> ❑ <br /> 7 rj <br /> 2. 6 0�- � 1 / DI`/ ( ' \ / / n ❑ Unit230 0 <br /> kL <br /> t --- <br /> 4. �w . l Gia f 3 <br /> N� ' � at" \ <br /> CAR 4 <br /> 6. 7 — P ten ' „ 5,y ( 7lJ ✓ �� <br /> 7. ' Q c S7( _ // nt5 <br /> 8. <br /> 9. � // � ZU <br /> nlf 6 <br /> 10. A - A/j C /a Cj // <br /> Specific Date Range of Information Requested: From to ISI <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK (UST) CLEANUP SITE (LDP) 0 HOUSING ABATEMENT r3SOLID WASTE FACILITYNaHICLE <br /> W OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY E3 WASTE TIRE <br /> P- ERGROUNO TANK (MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> IAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 171 MOTELIHOTEL 13 PUMPER TRUCKIYARDICHEM TOILETS <br /> t3 TATTOOIBODY PIERCING ❑ POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 Aw&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) 464.0138 or mall 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 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 END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a $105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 46.06 6/04/08 PUBLIC RECORDS RELEASE APP FORM <br />