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RECEIVED 9168518177 APEX. ENVIROTECH PAGE 02/02 <br /> PATE RECEIVED EHD LOG NUMBER <br /> "AY 0 4 2011 ""� SAN .1oAQUIN COUNTY "� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTH 600 East Main St. Stockton, CA 95202-3029 a <br /> PERMIT/SERVICES Telephone: (209)468-3420 Fax: (209)464-0138 Web, WWW-Sj90V_Org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1OM eu�livoj1 13USINESSIAGENCY: Apex F4?)�,s-1 +E nd <br /> ADDRESS: 1 Liq r iiY,s CITY/STATE/ZIP. <br /> PHONE (1): %H (2): p-1q4 170~ �69 FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: 5-1 I"iQoi I Time:__J(' 06 A/ — <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE RE QU T-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE s1J11 U11 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 Street Name City Unit 1 <br /> zfi . �s.c�.-4-r� <br /> 2. <br /> a Unit� 5 <br /> 3. <br /> 4. <br /> Eq-tTnit 3 <br /> 5. <br /> 5. <br /> Unit4 <br /> 7. <br /> $ ❑Unit <br /> 9. <br /> 10. <br /> ❑Unit <br /> Specific Date Range of Information Requested: From I 1 <!4 to app L <br /> 9L-O'?* 15a'l- ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> CI TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REvIE:W: MONDAY-FRIDAY 8:00 AM-5:00PM(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 least one file type MUST be selected, ax to 209 464-0138 or mail to tho address Intl; ated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received 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 tan(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 /> 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 /> EHD USE ONLY <br /> EHD es.99 <br /> 07120110 <br />