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-234=0538 Une 1 1 6 a.m. 10-23-2012 1 11 <br /> DATE RECEIVED EHD LOG NUMBER <br /> Rr-uElVED • - SAN JOAQUIN COUNTY ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> flfl11�� 1868 East Hazelton Avenue, Stockton, CA 95205-6232( 3 Wephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> ENWRONMEM'ALHEALMPERMIT . <br /> ISERVICES <br /> PUBLIC-RECORDS RELEASE APPLICATION <br /> APPLICANT: BlJ51NESSfAGENGY: <br /> ADDRESS: j �i� li/F—SrCITYISTATEIZIP:_ ( , ,%D�� <br /> PHONE-(1):- z ;�3j/ HONE.(2): FACSIMILE.,,� _ <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQU 25 F (CASTOR CHECK ONLY)-REQUEST PROCESSED IN 3 BUST ESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ] List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> ❑Unit 1 . <br /> 1. <br /> 03-7_1A) �57_e2�/47 J <br /> wa f �— ❑Unit 2 <br /> 3. <br /> 4. p�nit3 <br /> 5. G/D� s I_ X Kai � 5l 10i! jhSii✓ 17iSim C,tiN � <br /> 6. Fi� S f r /hJ l ,�nit a rL- <br /> 7. <br /> 8• i]Units <br /> 9. <br /> 10. p t7nit 6. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUNDTANK(UST)CLEANUP"SITE(LOP) Q}I011S[NG An7jr ENT T_- SOLID WASTE FAC1Lm�I1lEHICLE <br /> ROTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> UNDE4GROUNDTANK(MONITORING/RcmovAL) ❑DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL E]PUMPER TRUCK(YARD/CHEMICAL TOILETS <br /> TATTOOIBODY PIERCING ❑POOLISPA ❑LAND-USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC P3=RmiT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY&OD Am-S:OOPm(EXCLUDING HOLIDAYS) <br /> 1. List;un 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 fifes will be held.for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A flle 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 /> RPrPiv'P fI 1470 snrs� <br />