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11/04/2011 14:33 8884443080 PEM PAGE 01/01 <br /> I YAV E L`;"" 0 9 <br /> DATE acnF;ivi=n EHD LOG NUMBER <br /> SAN JoAQUIN COUNTY <br /> V Q 4 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTH 800 East Main 5t, Stockton, CA 95202-3029 <br /> PERMIT/SERVICES Telephone: (209)488-3420 Fax: (209)464-0188 Web:www.sjgov,org/ehd <br /> PUBLIC RECORDS RELEASE APPLICAT N 'r <br /> r <br /> APPLICANT: //✓� p�2.. I BUSINESS/AGENCY: <br /> ADDRESS:f�%-0® IlV< s3 'F CITY/STATE/ZIP: <br /> PHONE(1): `r`/sem a0­5;7 o ' PHONE(2): FACSIMIL <br /> TOVTATIVEX APPOINTMENT DATE: Time, <br /> (Please allow 10 buain09D doya f to of opplioation oubm 1 RTenfativo only-muet ba Confirmod) <br /> ❑CHECK BOX TO EXPEDITE REQUES C O C NLY)-REQUEST PROCESSED IN 3 BUSIN S DOPS <br /> SIGNATURE OF APPLICANT CRATE <br /> Electronic information: ❑List❑ ap—Description: <br /> FILE ADDRESS _ EHD USE ONLY <br /> Street Street Name - City ELUnIt 1 <br /> [2 2. ! L D �/ 1N Unit <br /> L r <br /> 4. luni <br /> 5. 65 ,JN"u ti1 �(d� <br /> 6. <br /> 4» C ....., ......._UnitA <br /> $ ❑Unit 3 <br /> 1®• - nit s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE$ <br /> NTHER <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ©HOUSING ABATEMENToo OLIO WASTE FACILITYNEHICLE <br /> CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ASTE TIRE / „1 <br /> NDERCROUNDTANK(MONrroRINGIRWOVAL) ❑DOC KGNN6L Ry <br /> XW! / <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> IERED PeRwTTED FACILITY ❑MOTELIHOTELUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATTo4/BODY PIERCING ❑POOLISPA LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR IREViEW: MONDAY-FRIDAY 8:00 AM-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. List un to ten address 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 typo MUST be selected. Fax to(209)464-0138 or mail o the address indicated above. Address <br /> ranges will not be accepted-for additional assista"be with filo addrosies,contact the EHD. Appliontions received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any FHD 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 Wuhiur,*day*fur 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 /> ENO UGr ONLY <br /> /— 7 O— <br /> i <br /> EHD 48-06 OT/29110 <br />