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SAN .JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT �y <br /> S .? j 3 2011 600 East Main St. Stockton, CA 95202-3029 <br /> S F P 1&Zpone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> NVIRONMENTAL H�E�Lft <br /> PERI 46AWAL HEALTH <br /> PERMITISERVICEIbUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: (C)CIckr� OA60t / SUSINESSIAGENCY: 1' N <br /> ADDRESS: _�J N" �I J I"t� / V� S'IC. CITYISTATEIZ',IP: <br /> PHONE(1): r* SII PHONE(2): ?�o 3ZI FACSIMILE: a�� Z79 20� <br /> TENTATIVE"APPOINTMENT DATE: 4-Z,+-1Time: 30 <br /> (Please allow tD business days from date of application submittal•"Tentative only.must ba confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQU $125 FEE( ASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 9-13-1) <br /> Electronic Information: ❑List❑ Map—D criptlow <br /> FILE ADDRESS EHD SE ONLY <br /> Street# Street Name City lif Unit 1 <br /> 2 j j3 "LCI' :ZnlOftZ_ GIS'1 e- IW <br /> 4, t Unit2 <br /> 3. J a01 Z„14&6 ' Pia W <br /> 5. <br /> 6. It-U-1 It 4 <br /> 7. <br /> $. El Unit 5 <br /> 10. ❑unit 6 <br /> Speolnc Date Range of Information Requested: From QrI(Ctr to gyp, reje4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT E]SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINDIREMOVAL) r-1DOGKENNEL El DAIRY <br /> g2AZAROOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMRTED FACILITY ❑MOTELIH07EL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC,PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(ExCLUDINO 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(2091464-0138 or mall to the address indlcatad 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 EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 d¢posit prior to review. <br /> ,-tin�19C 011U' <br /> EHD 46-06 tlltll1 <br /> TO 3DVd NOcII803ON3 96LT66960Z ZZ:VT ITOZ/£T/60 <br />