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—` A "& §888 'DN W� . . '6 6101 'Zl 'unpsrauil paniaaa8 <br /> ATER'.- -" <br /> DR -E' SAN JOAQUIN COUNTY <br /> JUN 12 2013 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> E r;C3U11�ui TRt HFAITEilephone; (209)468-3420 Fax: (209)464-0138 Web. www.sjgov.o /ehd q <br /> PERMIT(SEWICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: iso- "A.3 Ae61SC BUSINESSIAGENCY: C41 KCO pi✓ <br /> ADDRESS: 3Y5YMarla..:i 411-e CITY/STATFJZIP: gac CAT <br /> PHONE (1): 7/4 480. ?,X)L8 PHONE(2): FACSIMIL : ?rt Y8 D GIG 61 <br /> TENTATIVE`APPOINTMENT DATE: Tim : <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must b confirmed) <br /> []CHECK BOX TO EXPEDITE REQU T-$125 FEE(CAS CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DAT <br /> Electronic InforTnation: ❑ List Map-Description: <br /> FILE ADDRESS E D USE ONLY <br /> Street# Street Name city --� Unit 1 <br /> L \ 2. ❑Unit 2 <br /> 3. <br /> 4. kj 0 <br /> 6. <br /> 6' 1771 Unit <br /> 7. <br /> 8. <br /> Unit <br /> 9. <br /> D. <br /> ❑Unit 8 <br /> $peck Date Range of Information Requested: From to <br /> rr--'11 ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> L;I UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID ASTE FACWTYIIVQEHICL�E ^ <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSINe ABATEMENT ❑WAST TIRE 3 f�5 <br /> UNDERGROUND TANK(MONITORINcIREMOVAL) ❑FOOD FACILITY ❑DAIRY 1� -�1-l3 <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PtW <br /> ZARDOUS WASTEIHAZARDOUS MATERIALS-. ❑MOTEUHOTEL ❑PUM TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY, ❑POOUSPA ❑LAND I ISE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00 M(EXCLUDING HOLIDAYS) <br /> 1. List UP 10 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 Ale type MUST be selected. Fax to 12091464-0138 or mail to the address Lr(dlcaled above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Apj iIlcations received ager <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 confir ned approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum 01 five business days for IeView. 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 /> a. Any file not returned In the same condition as released will be reorganized by EHD staff at the a pense of the applicant. <br /> Future file reviews by the same applicant <br /> may require a$125 deposit prior to review. ""'80, O ARt A cEHO;'UBE ONCY <br /> ... ..,, . .. 714,,. ..,.:r,.. <br /> 14 <br /> C' <br /> ..... pCWea05—4B <br /> Y..-toff..=PPR•;' 41i1 ,Ie� .ftariiM,:.'=':;A;;° ~,... <br /> Ieratx <br />