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Frcm: K1einfP1der 2014.8 575 3444 06/16/2011 10:46 #122 P.0011001 <br /> RICIN ... <br /> LJ <br /> DA it EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HE; ENVIRONMENTAL HEALTH DEPARTMENT <br /> PERMIT/SERVICEB�FH 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www,sigov.org/ehd <br /> li <br /> PUBLIC RECOR�D^S RELEASE APPLICATION <br /> APPLICANT: J BUSINESS/AGENCY: P� <br /> ADDRESS: GfTY1STATE121P: 0 <br /> PHONE(1): _ .�,�,?=� PHONE(2): FACSIMILE: t-5- 3 <br /> TENTATIVE APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from d f of pplicatioLONLY) <br /> Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$122 F E(C SH OR CREQUEST PROCE=SSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT r DATE <br /> Electronic Information: <br /> ❑List E]Map-Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name City I <br /> 1 � tJ�eCk � ❑Unit 1 <br /> 2. aQ oa�z h <br /> 3� it2 ct q os= - <br /> s. t <br /> 4. <br /> Unit 3 <br /> S• r ,/ <br /> 6. <br /> 7 Unit 4 <br /> 8. <br /> B I Unit 5 <br /> 14. <br /> Unit s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> gUU ERGROUNU TANK(UST)CLEANUP SITE(LOP) ElHOUSING ABATEMENT OLID WASTE FACILnYNEHICLEVTR CLEANUP SITE(NON-LOP) ❑F000 FACILITY RIVASTE TIRE 1 <br /> ,L-7UNWRGROUND TANK(MONITORENGIREMOVAL) El DOG KENNEL AIRY € <br /> L'>J AZARUOUS WASTE GENERATOR ❑CHICKEN RANCH ASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTEI)FACILITY ~ ' <br /> ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑P09JJSPA <br /> USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY <br /> THER(PLEASE SPECIFY) �1t <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am- :OOPM(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 feast one file type MUST be selected. Fax to 209 464.0138-or mail 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 pm wilt 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 /> I <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 /> EHO USE ONLY <br /> EHD 48-06 - 07/29110 <br /> F <br />