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05/05/2011 06:50 12093396362 #0304 P. 001 /001 <br /> RECENED <br /> DATE RECEIVED EHD LOG NUMBER <br /> 0 5 2011 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> 15;L <br /> PERMIT/SERVICI=S <br /> ENVIRONMENTAL HEALTF!<eiePhone: (209)468-3420 Fax: (209)464-0938 Web. www.sjgov,org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: f /f�7 -_ 0z BUSINESSIAGENCY:/;1/0 0,gl- 1,-VRA/l4U <br /> ADDRESS: CITYISTATEIZIp: 7CIC/�T�°/L^ <br /> PHONE(1): 9 ' 3 p PHONE(2): ` d/ P,l( FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-°7 entativo only-mus#ba confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$122 CA CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE - J/ <br /> Electronic Information: ❑ List❑Map-Description-:_ <br /> FILE ADDRESS EHD USE ONLY <br /> Street 4 Street Name City ©Unit 1 <br /> 3 325, <br /> 2. ❑Unit 2 <br /> 3. <br /> 4. <br /> 5. units �� <br /> 8. pGit4 <br /> 7. <br /> S. <br /> M unit 5 <br /> 9, <br /> 10. <br /> ❑Unl 6 <br /> Specific Date Range of Information Requested: From to 777477-7.77"y-7— <br /> . ENVIRONMENTAL HEALTH DEPARTMENT FILES - <br /> RGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FAaU-rYIVEHICLE <br /> M <br /> R CLEANUP SITE(LEON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> RGROUND TANK(MONTTORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> A7ARDOUS WASTE GENERATOR ❑CHICKEN RANCH ©WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATT001$ODY PIERCING ❑.POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ WDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT-RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRmAY 8:00 AM-6:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the types)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 now 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$42.2 deposit prior to review. <br /> EHD Uar ONLY <br /> EHb 48 06 <br /> 07129110 <br />