Laserfiche WebLink
MAY-09-2011 MON 03;49 PM FAX NO. P. 01 <br /> RECEIVED -. � . .. _ ..._._. <br /> P <br /> 011 EHD LOG NUMBER <br /> 0 <br /> °� 1 h <br /> � SAN .�OA(.�ItJIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTH 600 East Main st. Stockton, CA 95202-3029 <br /> PERMIT/SERVICES <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 web; wvvw,sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESWAGENCY:.I�rlke� <br /> APPLICANT: }�4 re_ ro _ ----_ 9y f S <br /> AD13RESS: 50 �-rrMI)nA � . �ih ��o L---- CITY/STATE/ZIP: Son�,,c� <br /> PHONE(1): 159)-75 .2 PHONE(2):,(2�/S)s0 FACSIMILE: 6//S611-7y/Q <br /> TE'NTA7IVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of appll,:atlon submittal•*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH()R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 4Z _ DATE <br /> Electronic Information: Q List(] Map–Desorption: - <br /> FILE ADDRESS ,—_ EHD USE ONLY <br /> Street# Street Name Clb —_ unit 1 <br /> —••.r <br /> 1• �60�_ l-,Ls.s_-�.C�Cd..rsJ�.S.�.r��— :— .- r-�-��� 51-Gntt 2 <br /> 3.4. <br /> — � <br /> Unit s <br /> 5. <br /> Unit 4 <br /> 6. <br /> 7. . <br /> 8. .._ —._ �. ... F3 Units <br /> 10. I ❑unit <br /> Specific Date Range of Information Raquesd� From <br /> FENVIRONMEN rAL HEALTH DEPARTMENT FILES1�111T <br /> NDEROROUND TANK(UST)CLEANUP SITE(LOP) C I HOUSING A13ATEMFNT d SOLID WASTE FACILITYNI:HIGLFWASTE TIRE <br /> OTHER CLEANUP SITE(NON-LOP) C;I FOOD I-ACILITY ❑pA ST <br /> RY <br /> UNDERGROUND TANK(MONITOR [I D00 KENNEL -❑ ASTEWATER TREATMEN r PLANT <br /> `�OAZARDOUS WASTE GENERATOR [.I CHICP.I:N RANCH PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> 'g�IEREP PERMITTED FACILITY [ )MOTEL)HOTEL <br /> [� [:) <br /> POOLNPA SUAND USE APPLICATION Si <br /> TATTOOIBOOY PIERCING ITES <br /> �] OTHER(PLEASE SPECIFY) <br /> MEDICAL WASTE FACILITY [.J <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY S:OD AM-5:00PM(EXCLUpINCs HOLIDAYS) <br /> 1. L s u en a dresse in the space above. SeDfct the type(s)of files from the list above by checking the appfopriate <br /> box(es). At least one file type MUST be selected. Fax tp 2 464• 38 o ail o he a rens dic dab ve_ Address <br /> ranges will not be accepted-for additional assiarance 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 tcn(10) <br /> days after receipt of application. The files will b:held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. 1 <br /> 3. A file that Is actively being worked on by 6HD 811tff may not be Immediately available for review. Anew applicati� <br /> submitted when the file Is available. as n.,[eased will be <br /> 4 FAny file not returned in the same uture file reviews by the same applicant condition <br /> omay r rquire a$1222 deposit Pr oa to by at the expense of the�pk <br /> 1 iHP USE ONLY <br /> 07129116 <br /> END 46-06 <br />