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FDD `"' SAN JOAQUIN COUNTY `'r EHO LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> OUT 3 0 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3421 -F4,x.*'.(Qa9)464-0138 Web: www.sjgov.org/e <br /> ENVIRONMENT HEALTH I 1 t 7 <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ca BUSINESSIAGENCY: <br /> ADDRESS; �� / f sjy( / Cltylstetelzlp - <br /> rr - <br /> PHONE(1): - PHONE(2); <br /> TENTATIVE*APPOINTMENT DATE: VP Time;_,444(4 <br /> (Please allow 10 business days from date of aWicttion submittal-*Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST- E(CASH CHECK ONLY)-REQUEST PROCESSi;p IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE (> (� <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name CI1y <br /> 1. -7761 11 Unit 1 <br /> 2. u a It f' ❑ Unit <br /> S- Q A ft /1 t t f t /\ <br /> 4^ rt !I t1 n 11 (r; Unl \" <br /> 41 tt unit <br /> g, © Unit 5 <br /> t� It It 11 t t Il a aZ <br /> s. 3 li Fr <br /> 10. Unit 6 <br /> 1� <br /> Specific Date -Ran g­ <br /> ange of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) t7 HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MOWTORINGIREMOVAL) DOCS KEN?IEL, ' ' - 0 DAIRY <br /> XHAZARDOU9 WASTE GENERATOR G7'CHICKEN RANCH ©WASTEWATER TREATMENT PLANT <br /> ©TIERED PERMITTED FACILITY ©MOTEUHOTEL ❑PUMPER TkuCKIYARNCHEM TOIt.QTS <br /> C3 TATroofSoDY PIERCING ❑POOLISPA 0 LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL,AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REviEw- MONDAY-FRIDAY 8:00 AM-5;00PM - EXCLUDING HOLIDAY$_ <br /> 1. list up to ten addresses In the spare 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)464-0139 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant if any END fil®>�exist..,An.appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application, The files'will�ti'e Id ftir 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 END 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 END staff at the expense of the applicant, <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> END USE ONLY <br /> t <br /> EHD 46-06 B/04/05 PUBLIC RECORtiS RELEASE App FORM <br />