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11 / 30 / 2009 11 : 54 FAX 8002 / 002 <br /> EHo LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> Nov 3 0 2009 ENVIRONMENTAL HEALTH DEPARTMENT , <br /> N Epp East Mala St, Stockton, 01 8 Web : www J9 9 �� <br /> ENViRGI�1�utNT hone: (209) 468-3420 Fax; (209) 464-p138 Web : wwws' ov.or 1 (J <br /> PERMITIRV� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: G PSROS BUSINESS/AGENCY: rte( 3Caw1GmS IrJ C - <br /> ADDRESS: �+L}`Z M(�{�E,o41 A,\,e � SerrTe C, CITY/STATEIZIP: Skc -94/tEEft ' fl OS'82- / <br /> PHONE (1 ): C90 - 0?"SLJ PHONE (2): (9K ) 9P0/q -149 Ig FACSIMILE: 1(b ego ^ OGo� <br /> 7-ENTAT/VE" APPOINTMENT DATE: ILLT/oq Time: 0 $c7D <br /> (Please allow 10 business days from date of epPlicatlon Submittal - •Tantathm only - must be coMlrmad) <br /> CHECK BOX TO EXPEDITE REQ - 15 F (CA L# OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS/DAYS <br /> SIGNATURE OF APPLICAN DATE <br /> Electronic lnfor nation: ❑ Lis Map — Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street # Street Name city J 0 Unit 1 . <br /> 3, 57� 5- <br /> 4' <br /> s. <br /> s, V 4 <br /> s. <br /> Unit 5 <br /> 9. <br /> 10. <br /> ❑ Unit 8 <br /> Spmift Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br /> NMER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br /> &OOII <br /> y DERGROUND TANK (MONBORINGIRLMOvAL) ❑ DDG.KENNEL ❑ DAIRY <br /> &HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKNARDICHEMICAL TUILETS <br /> 0 TATTOOIBOUY PIERCING ❑ POOLISPA ❑ LAND 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-5:0OPM (EXCLUDING HOLIDAYS) <br /> 1 . List up to ten addresses In the apace above. Select the typat(s) of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST " selected. Fax to (209) 464,0135 or mail to the address IndicategA ve. Address <br /> ranges will not be accepted - for addigonal 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 ten (1U) <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 he immediately available for review. A now application may be <br /> submitted when the file Is available. <br /> 4. Any file not retumed 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 $116 deposit prior to review. <br /> 5. N you need further assistance, please contact Diene Martinez, at (209) 46&3426. <br /> END USE ONLY <br /> EHD 48 06 0127109 <br />