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RECEIVED SAN JOAQUIN COUNTY EHD LOGNUMBE <br /> NOV O 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: " t� j f -A- BUSINESSIAGENCY: „� ► �•1� <br /> ADDRESS: yt1arao..� tiYtalt4f.�u•ri - s. CITY/STATE/ZIP: X5$21 <br /> PHONE (1): 011�\ q10- 014" PHONE(2): (33o> zt- 1!44. FACSIMILE:. y$a- obb3 <br /> �, <br /> TEN AT! E'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal--TentatwQ only-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 � �_ DATE (aI41 J(r <br /> Electronic Information: List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name City Unit 1 <br /> I�aZ _.. Unit 2 <br /> 3. 2�o e <br /> 4. ISZB 1 ` <br /> Unit 3 <br /> 6. r � zf ��/7C�'p F Illi unit4 <br /> 7. r}cl <br /> Unit 5 <br /> yr <br /> 10. - <br /> Unit B <br /> SpocHic Data Rango of Information Requested: From A►_l. to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IIER <br /> ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSINGABATEMENT �QLID WASTE FACILrry/VEHICLE <br /> ER CLEANUP SITE(NON-LOP) E]FOOD FACILITY [}'VGE�$7E TIRE <br /> ERGRQUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL aVy Y <br /> ARDOUS WASTE GENERATOR ❑CHICKEN RANCH L�WATEWATER TREATMENT PLANT <br /> ED PERMITTED FACILITY ❑M EL/HOTrL [�P"` PER TRUCK/YARDICHEMICAL TOILETS <br /> ,�C F]TATTOOIBODY PIERCING 0LISPA AND USE APPLICATION SITESr <br /> �IEDICALWASTE FACILITY OPER /�r�,r recarols O e�+�n►aKthtw ! Covurewt- <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:06PM(EXCLUDING HOLIDAY$) <br /> 1. List un 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)464-0136 or mall to the address intiloated 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 END 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 ae released will be reorganized by EHD staff at the expense of the applicant. <br /> Future flle reviews by the same applicant may require a$122 deposit prior to review. <br /> PHI)LISP ONLY <br /> EHD 4a-0e <br /> Orl49ri 0 <br /> L00/1001] XUj 60 LO LLOZ/ZO/LL <br />