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I I/ IV/4V IU V�j.tr rriA 4001/001 <br /> " C VED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 1 0 2010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St- Stockton, CA 95202-3029 <br /> ENVIRONMENTAL HIRV <br /> hone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/eh <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATI <br /> 7 <br /> APPLICANT: El;;:"N-bS BUSINESS/AGENCY: �((cES <br /> ADDRESS: SgI4 jo0e.t,pr_4( zV,5 CITY/STATE/ZIP: S4_2AK-'r-" r <A '95$IV <br /> PHONE (1): PHONE(2): 0(ogto-Zeis FACSIMILE: 410 490-or"07 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of appllcatlon submittal-'Tantatfvo only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUE EE OR C ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE S` f <br /> Electronic Informatlon: ❑List rMap—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name Clry Unit 1 <br /> 2. 12`�S QST �T Lei ( - — ❑Unit 2 <br /> 0- F tr L�4 f <br /> 4. nk 3 <br /> 5. <br /> 6, <br /> 7. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> Unit 8 <br /> SpeclFlc Date Range of Informatlon Requested: From ALt, to �-I~ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ElHOUSING ABATEMENT -1 SOLID WASTE FACILITYNEHICLE <br /> OTHER GLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/RFMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HA7ARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑ <br /> TATTOO/BODY 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-5:00PM(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.adidress 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$122 deposit prior to review. <br /> EHU USE ONLY <br /> EHD 4808 07129/10 <br />