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26/2011 15:17 2693338363 LSDI DOWNSTAIRS PAGE 62/02 <br /> RECEIVED 1-H0IACs NUMBER <br /> SAN JQALIUIN COUNTY <br /> MAY ENViRONIVIENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> EWRONMENTALHEALVephone: (209)468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd <br /> pERMiTISERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �In� Ch-�:rL�.�V - - <br /> BUStNfS31AGI=NGY: NCAA <br /> ADDRESS: _2_Q2 l -dLSIa1 oy _ cltylstetelziP <br /> PHONE(1): _M9_74Z_Q640_ PHONE(2). �Q_CF�AI,CSCIMPI,LE9:522409-.333A3 <br /> TENTATIVE*APPOINTMENT PATE: Please-call _Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX To EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-BEQUEST PROcEssED IN.3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ DATE _5-26-11 <br /> Electronic Information: List C'] Map-Description:_ <br /> FILE ADDRESS EHD USE ONLY <br /> S <br /> Streets! st Names CiEy <br /> (7 Unit 1 <br /> Sire <br /> et <br /> Brenran Road @{ 0-2-06 06 _FSCalcn _,.-_-- <br /> 'Unit 2 <br /> 2. 2070 Brennan Road <br /> 3. 20953.---.-----SrennarlRQ�0 -_-•-. -._----. Esq Ion Unita4. <br /> Q <br /> — J <br /> 5. UnitA <br /> B, <br /> —7' - - - -- --' - ❑ Unit 5 � <br /> S Unit 6 , <br /> - - - , <br /> 74. -- <br /> Specific state Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES � <br /> N UNDERGRQUNc TANK(UST)CLEAN UF`SITE(LOP) 0 HOUSSNG AEATt=M6NT GXSOLID WASTE FACILITYNEMCLE <br /> X OTHER CLEANUP SITE(NDN-LOP) 12 FOOD FACILITY O WASTE TIRE <br /> UNDERGROUND TANK(MONITGRINGIRLMOVAL) ❑DQG KENNEL DAIRY <br /> HA7ARDOUS WF,STE GENERATOR 0 CHtchw RANCH WASTEWATER TREATMENT PLANT <br /> Cl MFRCD PERMITTED FACILITY Q MOTELIHOTEL PUMPER TRUGKIYARDICNEM TOILETS <br /> TATTOOIBODY PIERCING F3 POOLISPA I LAND USE APPLICATION SITES <br /> *MEDICAL WASTr:FACILITY ❑OTHER(PLFASE SPECIFY)_WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY$:08 APA-5:,OOPM - EXCLUDING HOLIDAYS, <br /> I, 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 209 464-Q]313 or maii to the address Indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 prn will be processed the next business day. <br /> 2. The FHD wFI notify the applicant if any EHD files exist. An appointment for review-mill be confirmed approximately ten(10) <br /> days after receipt of application. The flies 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 ruviewa by the same applicant may requlre a$105 deposit prior to revio01. <br /> EHD USE ONLY <br /> EHD 48.08 V0410P PURLIC RECOBUS RELEASE APP FORM <br /> I <br /> I <br />