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'+4. "'E E ''NUMBER <br /> SAN JOAQUIN COUNTY <br /> v <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> A1j 0 �U 10 000 East Main St. Stockton, CA 952.02-2708 <br /> ENVIRuwLNTT tPe- (209)466-3420 Fax: (209) 464-0138 Web: www,sjgov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: llt�r~ J�S 1%�C <br /> ADDRESS: f#Y f//Q 4�� � CITY/STATEIZIP: ;/ Q� <br /> PHONE(i): 7(O� 70Z7 PHONE(2): �� e FACSIMILE: <br /> ��I� 0 <br /> TENTATIVE*APPOINTMENT OATS: Time' <br /> Ic?f17•r7 <br /> (Pieaao show lo business days frau date of appllcatlon subm ,-TTentative only-mutt tie confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST $115.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 TiUSINES"DAYS ! = <br /> SIGNATURE OF APPLICANT G G -� DATE O/z57/ <br /> Electronic Information: L] List❑Map—DescrfpUon: <br /> FILE ADDRESS FHD USE ONLY <br /> ��&trect Strevt Name City ❑Uotlt 1_ <br /> _1 !7(i --IJ _ <br /> 2.-r - IJU„tz <br /> 3. <br /> [41 1 lyurr�l s <br /> 5. <br /> G. Unit 4 <br /> 7. _j - .. . .. <br /> $ Q Unit 5 <br /> 9. <br /> 1� _ <br /> ❑Unit 6 <br /> 5peciflc Date Range of Information Requested. From to <br /> / ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UMOERGROUNP TANK(UST)CLEANUP&CTE(LAP) ❑HOUSM ABATEMENT <br /> SOLID WASTE FACILITYIYF�tICLE <br /> �OTHJER CLEAIiUP SITE(Nowl-0P) ❑FooD FACILITY ❑WASTE TIRE <br /> T5Unor4K mFt0 TANK 0rlOIirTOR*4ffl aAOVAL)^ ❑DOG KENNELHWASTEWATtRTRFATMENT <br /> DAIRY <br /> HAZAR6M WASTE GENERATOR ❑CHICKEN RANCH PLAIN <br /> ( )] <br /> TEW PEWW To FACILITY ❑MOTEIIHOTEL []PumPER TRUCKIYARDICHEMICAL TOILETS <br /> t ❑TATT'00MWY POMING �]POOUSPA. ❑L.ANP USE APPLICATION SITES <br /> ❑ WASTE FACILITY L]OTHER(PLEASE SPECIFY) <br /> WELL AND 9EPTIG PERMIT RECORD$ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8;00 AM-S:OOr M(EXCLUDING HOLIDAYO) <br /> 1. t-jt uo to ben#dgr snp In the space abovo. Select the typo(*)of flies from tiro list above by checking tho appropriate <br /> box(es). At least one file type MUST be Selected. Fax to(709)M--9130 30 or mail 19,the address indicated above. Address <br /> ranger will not be accepbad-for addltlonal assistance witfi file addresses,contact the EHp. Applications received after <br /> 3:00 pm will be processed the next busims s 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 hold for a maximum of five business days for review. Appolntments <br /> should ba echoduled accordingly- <br /> 3. A Elle that is actively being worked an by EHD staff may not be immediately available for review. A new application may be <br /> aubmittvd when the file is available. <br /> 4- Any file not ratumed in the same condition ae reloasod will bo reorganized by EHD staff at the oxpenso of the applicant <br /> Future file reviews by the same applicant may require a$118.00 deposit prior to review. <br /> EHp Usf ONLY <br /> *'If you need further assistance plaose contact A�IaP#iAcr directly IP (209)468-3425. Thank You*** <br /> /�h L4W� <br /> GUf AR— � aro99 <br />