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Oct-05.01 01:20p Diane Prevos' FR5-594-5763 p.1 <br /> RS C E- IVED 1, <br /> SA^J JOAQUIN COUNTY / EHD LOG NUMBER <br /> DEC 10 2010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 5 1� Q 4 t� <br /> 0 <br /> ENVIRONMENTAL HEAL-TMelephone: (209) 468- www.sjgov.org/ehd <br /> Fax: (209)464-0938 Web: w.sjgov.orgJehd <br /> PERMIT/SERVICES. PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: LJiC1ne ?re vos-f- 13USINESSIAGENCY: 0UQj-Lf 1R2j eco <br /> m�t� LLQ <br /> ADDRESS: 1-70Z Mc i",lCLDr-J\ CITY/STATEIZIP: �Cr E <br /> PHONE(1): (,W-- 708. 32(vS PHONE 2 O: FACSIMILE: Z <br /> TENTATIVE-APPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal-`tentative onl Time: <br /> y-must be confirmed} <br /> ❑CHECK BOX TO EXPEDITE REgUE $122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT_LL � ��,1 � f- DATE /oZ - /n- /Q <br /> Electronic Information: Q List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> F <br /> Street; Street Name city <br /> F1 Unit 1 <br /> Lone- L� t�9"T <br /> S L.O u i�5 e Lan La h rz� r <br /> 3. —_i 0-Unit 2- <br /> 4. <br /> 5 ©Unit a <br /> 6. <br /> 7 —- __ 0 Unit 4 <br /> 8. <br /> 9. - 0 Unit 5 <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range !of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE N <br /> ❑UNDERGROUND TANK(MONITORING/REMOVAL) [j DOG KENNEL El DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH _ ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEUHDIEL f <br /> ❑TATToomwY PIERCING ❑PO /S ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> 5T- El LAND USE APPLICATION SITES <br /> L] MEDICAL WASTE FACILITY POOL/SPA UNE`—OTHER(PLEASE SPECIFY) q�, 1e�Ji6ns <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA LE FO REVIEW: MONDAY-FRI"ClAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> I. 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 42091464-0138 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 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 /> EHD USE ONLY <br /> O, v\ " h Ei <br /> EHD 48-06 <br /> 07129!10 <br />