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EHO LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> �!'k 2 1 600 East Main Street, Stockton, CA 95202-3029 <br /> EN'1190NMENj.HEAD-1ePhone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.o <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: t N O� BUSINESSIAG,/E�NCY: � 5�O �/ <br /> ADDRESS: �gO N. .W� ,Ii lem, 81 ml J5 A CitylStatelzip Cl C0�_ _g raZZ <br /> PHONE(1): ZDq �N 7-ID�l'l PHONE(A2).: VA.PZI - 2�.r —FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: AAOt rCL' r/7-00Timo: O_30'Ax" <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE RE T- of EE(CASH OR CHECK ONLY).REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: El List❑Map–Description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street# Street Name pi 4 NCity E] Unit 1 <br /> 1. 4 o-4 Ui. STOOk-ForiS7: W i4o_o, __ o <br /> 2. (/�}, Mao exp. {{Wl4'ES 0015 P Unit 2 <br /> 3• t l I �� • I -- _ 3 <br /> • U'L <br /> 4. aao o usT i :,o�s,N� ��yP Unit N <br /> - —------ 5 .-...... ...._.-�- <br /> 5. � sl - <br /> "-" Unit 4 <br /> 6. I 1 U5r a o ccs/5 P <br /> 7. 1 -- <br /> _ u." �Ve; i,44� <br /> Unit <br /> IJDl znWlh <br /> g' Unit 6 <br /> 10. ao , o s. i U)1 Wcomi, <br /> Specific Date Range of Information Requested:From Cerltelj 01'H D4 /`QC4v� r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT 0 SOLID WASTE FACILITYIVEHICLE � /* <br /> BOTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY 0 WASTE TIRE <br /> ,y <br /> �I'LI'NDERGROUND TANK(MONITORING#EMOVALW- ❑DOG KENNEL 0 DAIRY <br /> O�H <br /> AZARDOUS WASTE GENERATOR ////�� 0 CHICKEN RANCH ID WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY O MOTEUHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOO/Booy PIERCING 0 POOLISPA O LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY 171 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 mail 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 he 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> y- 11 9 N ui <br /> r). US �° le <br /> r Q� <br /> q s. s. <br /> EHD 48-06 8/04/08 PUBLIC RKORDS RELEASE APP FORM <br /> ze/TO'd 66TO 998 SZ6 T GDIIJiJD ?IOONI 0AON9 22:9T 600E—TE—chid <br />