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----- - -------------- <br /> FROM:Chemstation TO:4640138 01/0-013 16:41:47 #26863 P.001/001 • <br /> EHD LOG NUMBER <br /> 1 f NEWNE® SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JAN 07 20131868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd f <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT..: - �i_ yf_l._�1`d .•-.,.,•.-- BUSINESSIAGENCY: ns�l77tr7/7b�r <br /> ADDRESS: �/3 —� �P ��!H CITY <br /> ISTATEIZIP: i_Lf fid SS?'�3 <br /> PHONE(1): 1, r— qY,f— 7y 7e PHONE(2): FACSIMILE: lot^ 9Cr3^ 7zi79 <br /> TENTATIVE"APPOINTMENT DATE: i -, Time: 2%00 Pte'' <br /> (Please allow 10 business days from date of appli atlon su mittal-'Toatarlva only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE OR C ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ DATE17 h 3 <br /> Electronic Information: ❑ List Map— escription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street p j Street Name City ._........._. ....__._—... ............ ....... O Unit 1., <br /> An <br /> 2 I Unit 2 <br /> I/ <br /> 3. ................. <br /> 4. .Ounit3, <br /> (p / I' <br /> O. ........... Unit 4. <br /> 7. <br /> :::........._,...__.._.....--._.... ..... <br /> B. i Units <br /> t0. Unit 6 <br /> Specific Date Range of Information Requested= From -„QG ^ I— I%f G to <br /> Z <br /> ENVIRONMENTAL HEALTH DEPARTMENT PILES <br /> ONDERGROuNo TANK(UST)CLEANUP SHE(LOP) [—)HOUSINGHOUSING ABATEMENT SOLID WASTE FAGILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY E]WASTE TIRE <br /> DERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑PA RY <br /> �AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH [�Vy STEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑M07ELIHOTEL ❑ MPER TRUCKIYAROICHEMICAL TOILETS <br /> ❑TAT 0oIBODY PIERCING ❑ OLISPA ND USE APPLICATION SIT E$ <br /> MPLAINT RF.COROS OTHER(PLEASE SPECIFY) �P Ue ~'� / <br /> ❑ MEDICAL WASTE FACILITY 7=�rf bIS <br /> Wsmi!! <br /> L D SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 0:00 AM-S:OOPM(EXCLUDING HOLIDAYS) <br /> 1. o ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> . At least one file type MUST ba selected. ssIdlcatedabove Address <br /> will not be accepted-for additional assistaApplications received after <br /> will be processed the next business day.2. will notify the applicant if any EHD files exs . ppconfirmed approximately ten (10) <br /> er receipt of applicat(on. The files will be hs for review. Appointments <br /> be scheduled accordingly.at Is actively being worked on by EHD staff may not be Immediately available for review. Anew application may be <br /> submitted when the Elle 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 deposit prior to review. <br /> I in i vu uw . <br /> sHo -_-_ __�) <br />