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REAvg. 10.2011 08:59 WES'TON SOLUTIONS INC OAKL 5108919710 <br /> CEIVE PAGE. 1/ 1 <br /> DATE RECEIVED <br /> SAN JOA <br /> A010 2011 QUlN COUNTY EHO LOG NUMBER <br /> ENVIRONMENTAL HEALTH Dr=pARTMENT <br /> ENVIRONMENTAL HEALT11600 East Main St. Stockton, CA 95202-3029 <br /> PERMIT/SERVICES Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:Ax-- 13E!$INES5IAGENCY:VI IV�VI a <br /> ADDRE$$: CITY/STATE/ZIP: <br /> PHONE(1); PHONE 2 FACSIMILE; <br /> TENTATIVE*APPOINTMENT[TATE: � l( Time: <br /> (Please allow 1Q bueiogme days from da of ppllcatfon submittal-'Te11fat1V0 only-must be canflrmed} <br /> ❑CHECK BOX TO UPEDITE RE T• 12 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSMESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑Llst❑Map—Description: <br /> DILE ADDRESS EHD USE ONLY <br /> Street# Street Name <br /> city <br /> -�. ��1 b �r5���.n��.._�o� r . ............. ..._.._.. . . . . ..... .. ....-----.-❑unit, <br /> z. — 0 f r Unit 2 <br /> 4. <br /> 6. <br /> ---- — _ — It 4 <br /> 9 ❑Unit 6 <br /> Unit 8 <br /> SPeciflo Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> JAZARDOUS <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ASATEMrmr .SOLID WASTE FACILITYIVEKnLE <br /> HER CLEANUP SITE(NoN-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> DERGROUND TANK(MONITORING/REMOvAL) ❑DOG KENNEL DAIRY <br /> WASTE GENERATOR CHICKEN RANCH ASTEWATERTREATMENT PLANT <br /> RED PERMITTED FACILITY ❑MOTELIHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATToolSODY PIERCINIG ❑POOLISPA D USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REview: MONDAY-FRIDAY 8:00 AM-6:00PM ExCLUD[NG HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Selcctthe 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)464.0135 or mail to the address if1dicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the E14D. Applications rocelved 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 hold 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 requite a$122 deposit prier to review. <br /> iHOUSE ONLY <br /> ENO 40-00 - .,.. •••,•-,...T,..-.,..,...,�7129f1R <br />