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V1110001 <br /> PD,,lob- ,I WED EHD LOG NUMBER <br /> l' <br /> t' SAN JOAQUIN COUNTY <br /> OR 21 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIRONMENT HEALTft-1ephorte: (209)468-3420 Fax: (209)464-0138 Web-, WWW.sjgov.o <br /> PERMITISEOCES PUBLIC RECORDS RELEASE APPLICATION qZ95% <br /> APPLICANT: I N 'D BUSINESS/AGENCY: F-NCSE O / <br /> ADDRESS: .-Wy ,/,hyla►_ 6VG Jk A City/StAte/Zip �l CO--_ <br /> PHONE(1): T10V l PHONE(A2): ,�� 3Zl FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: MDrC� r'i Time: '�'30/41' <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE RE' T-10 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE `L-21-Q6 <br /> Electronic information: ❑List❑Map-Description., <br /> FILE ADDRESS EHD USE ONLY <br /> Streat# Street Name City <br /> - ❑ Unit 7 <br /> �. 4 b C S7: off__ aJ <br /> 2. 14 W. Maio <br /> ��, Ma eca% 1111..,. �� C� 'vIc ❑ unit 2 <br /> 1602 N. f 11 9— vc r,1�r. ....... Unit 3 <br /> vj�_.. 3.5 - nit <br /> �- Unit s <br /> a019 o .61y <br /> ❑ Unit 6 <br /> 10. aQ in o - <br /> Specific Date Range of Information Requested:From Car11f13- to r46A /-eCe.,-,+ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 19XUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) Cl FOOD FACILITY ❑WASTE TIRE <br /> X+LINDEkGROUND TANK(MONITORINGIREMOVAL) C3 DOG KENNEL ❑DAIRY <br /> Z�HAZARDOUS WASTE GENERATOR - 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY (a MOTELIHOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br /> 0 TATTOOIBom PIERCING 13 POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM5:00PM - 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 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 role 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 /> EHD 48-DG 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br /> ZO/TO'd 66TO 998 SZ6 T (131U�JOdi'IODNI 030113 00:9T 6002-T?-Jdd <br />