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p 1{$1 J <br /> SANJOAQtiIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPART-MENT <br /> AUG 1 1 2005 304 East Weber Avenue, 31r Floor, Stockton, CA 95202-2708 jq313 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.Sjgov.or&/ehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS !RELEASE APPLICATION <br /> APPLICANT: t+- iN, m-lh BUSINESSIAGENCY: <br /> ADDRESS:_ Z-'Q Qv.W*" fir, Tur\.olj� �(S'S'61 <br /> PHONE(I): Z."A7 PHONE(Z): 2a1 WOO—Ca4'0FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: t3 z, T Time: <br /> (Please allow 10 business days from date of application submittal-•Tentave tionly-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$`913.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 USINESS DAYS <br /> SIGNATURE OF APPLICANT tiar—V —A DATE <br /> UNIT DISTRIBUTION ❑Unit 1 ❑ Unit 2 O Unit Unit it <br /> O Unit 5 O Unit 6 O other(eleWonWlists/maps) <br /> FILE ADDRESS <br /> s <br /> treet street Name oily EHD USE ONLY <br /> 15 2S E Frc „o w+ S�.SY�,+c [ Pd.o E. v� <br /> 10. V;SIL @. JJLprt 4 Led g ic CAl <br /> Specific Date Range of Information Requested:From 2,a4a3 to V ff Qm.�r- <br /> i <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> y� <br /> / UVDERGROUND TANK(UST)CLEANUPSITE(LOP) ❑HOUSING ABATEMENT 13 SOLID WASTE FACILITYNEHCLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TRE <br /> CI UNDERGROUND TANK(MONITORINGIREMOVAL) ^❑DOG KENNEL ❑DAIRY <br /> D4Mb*MO GwAsta4ev0WToR V � -d WAtevewAvMTffEYnlAeW4k"JT <br /> TIERED PERMITTED FACIUTY ❑MOTEUHOTEL O PUMPERTRUCKIYARD(CHEM TOILETS <br /> TATTOOMODY PIERCING O POOLISPA ❑LAND USE APPLICATION SITES <br /> 17 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW- MONDAY-FRIDAY 8:00 AN3'00pM . 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to 1209)4640138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will b'e processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files e�ist An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staffImay not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any fife not returned In the same condition as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> { <br /> EHD 0r-e3-006 <br /> 1110/05 <br />