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06/13/2011 15:16 209 303 LODI DOWNSTA PAGE 02/02 <br />RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br />JUN 15 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax, (209) 464-0138 Web: WWW.Sjg0V,Qr9/ehd <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: e e <br />NOA <br />ADDRESS:swidus"w <br />- 90 LIZCitylstatelzip <br />PHONE (1); PHONE (2): FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE, Please call Time: <br />(Please allow 10 business days from date of application submittal - *Tenfa(jvv only - must be —corm <br />In CHECK BOX 70 EXPEDITE REQUEST � $105 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS nAVQ <br />SIGNATURE OF APPLICANT <br />Electronic information, [3 List E] Map Description: <br />FILE ---------- <br />ADDRESS <br />Street Street i i� _a EHD <br />NN 1, 3940 N, TraCy Blvd <br />Tracy <br />3� 5 jWk) Ar - <br />2. 3925 N, Tr@cy Blvd T, 'qi3. <br />T, <br />14. <br />ONLY <br />Unit I <br />unit z <br />F7 unit <br />Unit A <br />7. <br />L. <br />9 <br />El unit 5 <br />lo, I I V Unit <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILE,'; <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOusINC, ABATEMENT <br />O&QkiD WASTE 5ACILITY'lVENICLE <br />OTHER CLEANUP SITE (NON <br />-LOP) M FOOD FACILITY 0 WANTE TIRE <br />UNDERGROUND TANK (MONITORING/REMOVAL) C] DOG KENNEL 0 DAII?y <br />HAZARDOUS WASTE GENERATOR OP- ❑ CHICKEN RANCH KWASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY 171 MOTEL/HOTEL <br />C3 TATTOO/BODY PIERCING ❑Ayr PUMPER TRUCKIYARDtCHEm TOILETSk <br />0 POOLISPA X LANE) USE APPLICATION SITES <br />0 MEDICAL WASTE FACILITY 0 OTHER (PLEASE AY -FRIDAY 8:00 Am-5:oOpm � EXCLUDING HOLIDAYS. SPECIFY) <br />AVAILABLE FOR REVIEW . MOND <br />WELL, AND SEPTIC PERMIT RECORDS ARE _ <br />1. List Up to ten addresses In the space above, Select the type(s) of flies from . m the list above by checking the appropriate <br />box(es). At least one file type MUST be sel'ectod. Fax tojZU9 4640138 aLmall jathea Ldgess i _ Rls�above. Address <br />ranges will not be accepted _ <br />— for additional -ISSiSt8rice 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 flies 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. 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 />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 $105 deposit prior to review. <br />r3T_r*TFE-T-_T2"W. <br />=I <br />