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RECEIE I IJUMBE <br /> VED SAN JOAQUIN COUNTY EHD LOG <br /> NOV 0 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: x `i�C►1 ��rt� BUSINESSIAGENCY: � .t-,;,;,,1„�, <br /> ADDRESS: CITYISTATE/ZIP: <br /> PHONE(1): �q��—�{ ,• p� {, PHONE(2):(> Zt- 5+t. FACSIMILE: 91.6 ysa- >Sbo3 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'7entafive only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE 12EDUEST 122 EEE(CASH OR CHECK ONLY)-REQUEST PROCESSE4 IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ DATE fci 13 (1 <br /> T <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> - Street I' Street Name CL 1City Unit1 <br /> �• �(o3CJ ^. __ KlD ih4 �1.+1lrKtlQ C�V �'P�1clo�n <br /> (l02 Unk2 <br /> 3. 25io a �'I <br /> 4. �SZB k 1 J . Unit 3 <br /> 5. v_A �U <br /> F /lli Unit 4 <br /> 7. [tc . <br /> Unit 5 <br /> 10. <br /> Unit 8 <br /> Specific Date Range of Information Requested: From /IlL-1.. to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 11 DERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT L!� LID WASTE FACILrrYNEHICLE <br /> ER CLEANUP SITE(NON-LOP) ❑F000 FACILITY WaIRY <br /> E TIRE <br /> A01 U <br /> jFARDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL , <br /> WASTE GENERATOR ❑CHICKEN RANCH L�WA�TEWATER TREATMENT PLANT <br /> OUS <br /> EO PERMITTED FACILITY ❑MQJELIHOTEL P" PER TRUCKtYARD/CHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ��L/SPA .AND USE APPLICATION SITES <br /> �IIEDICALWASTE FACILITY THER(PLEASE SPECIFY) /�„,� r[corals O eK�nroKn�tw C4+1c�rr,. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:O�PM(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(2091 464.0136 or mall to the address logloated 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 he 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 /> !ND USE pNLY <br /> EHD 48-ue <br /> 0?129110 <br /> L001L00Z XVI EE Zo [[WZ 0/1. L <br />