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R 'd; E E Iv! ER <br /> SAN JOAQUIN COUNTY EHD LOG <br /> NOV 15 2010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: kvww.sjgov.org/e <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: G t' l ` <br /> ADDRESS; r �.� SI �� Q CITY/STATE/ZIP: �j C�4L3 <br /> c. <br /> PHONE(1): � , - F - r. ---fin �n r� �C�� � <br /> � — PHONE (2): jG_- -q T - 99 j FACSIMILE: <br /> �c <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal-`Tentative only Time: _ <br /> y-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST:$122 FEE!CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ,G DATE <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name <br /> City <br /> 1. --`---- ------- -- �_.—_ _— —— Unit 1 <br /> Unit 3 <br /> _1�? T 7. U— Unit 4 <br /> 8. q <br /> 9, N+. Unit 5 <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From LL <br /> ENVIRONMENTAL HEALTH DE ARTMENT FILES to <br /> Q'(/NDERGROUND TANK(UST)CLEANUP SITE(LOP) LOUSING ABATEMENT OLIO WASTE FACILITYNEHICLE "I IL / � <br /> C�OTHER CLEANUP SITE(NON-LOP) Eif OOD FACILITY ['WASTE TIRE <br /> C�UNDERGROUND TANK(MONITORINGIREMOVAL)(y �OG KENNEL Q DAIRY A . <br /> [��1 iAZARD0U5 WASTE GENERATORS `�\ D-CHICKEN RANCH DWASTEWATER TREATMENT PLANT 11-11-10 <br /> EaTIERED PERMITTED FACILITY [2MOTELIHOTEL <br /> ['TATTOO]BODY PIERCINGQ'PUMPER TRUCKIYARD(CFIEMICAL TOILETS <br /> ��vitD1CAL WASTE FACILITY [OTHER( <br /> OTHER(APLEASE SPECIFY) DWI)USE APPUCATION SITES <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 A?4-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above b checking the appropriate <br /> box( i. At least one file y 9above, Address <br /> ranges will not be accepted-for additional assistance with file addresses,ontacttthe EHD,he sApplicatiApplicationss indicated received <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 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 /> EHO USE ONLY <br /> `�IOCn <br /> EHD 48-06 <br /> 0712911 D <br /> Z-d 099L-Z69-96b e01501080 d09:Z0 06 96 AON <br />