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01-10-12; 1 AM; ;916 679 2422 9 <br /> DATE RECEIVED <br /> �T � EHD LOG NUMBER <br /> g� SAN .IOAQUIN COUNTY <br /> REUaEIVE ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> JAIJ 10 2012 Telephone: (209) 468-3420 Fax: (209)464-0138 Web: wWW.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC /RECORDS RELEASE APPLICATION <br /> �/� <br /> APPLICANT: [////�I/ �/C/CC(w/ BUSINESSIAGENCY: Ut��l�,.' ' <br /> ADDRESS: �/��/J� Ga it��Gt�Sf/r CITYISTATEIZIP: ( yit�r�/rti/� &( ( q 33 <br /> PHONE(1): /IYl 67g1a3/3 ' PHONE(2): SIG 2-&l 1v�0 FACSIMILE: "//4,607"/ .2GIV0 <br /> TENTATIVE'APPOINTMENT DATE: l Z3 12 Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEJ $125 FEE(CASH OR CHECK ONL -REQUEST PROCESSED IN 3 B SIN SS DAYS <br /> SIGNATURE OF APPLICANT [ �l L M&qDATE 11q11.2 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City _ ❑Unit 1 <br /> 1 ! SO �q <br /> 2. XIL _ ❑Unit <br /> 3. t �� <br /> 4• Unit 3 <br /> 5. - <br /> 6. / Unit 4 <br /> 7. <br /> 6. -❑Unit 5 <br /> 9. <br /> 10. ❑Unit 5 <br /> Specific Date Range of Information Requested: Froml///1�J50 to IMIZ <br /> ENVIRONMENTAL HEALT DEPARTMENT FILES <br /> ILL <br /> NDERGROUND TANK(LIST)CLEANUP SITE(LOP) [-]HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) E-1Fool)FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑Doc KENNEL ❑DAIRY <br /> TA2ARDOUS WASTE GENERATOR El CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: 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. Fax to(209)464.0138 or mall to the address Indicated 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 ten(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$125 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 46-06 611111 <br />