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CIA N aJUAWUIN I,OUNTY �r <br /> NOV 02 2011VIRONMENTAL HEALTH DEPARTt&'111111116t <br /> 00 East Main St. Stockton, CA 95202-30< <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.s gov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICA ION <br /> APPLICANT: �.cTxvt puvtt BUSINESSIAGENCY: 11C., <br /> ADDRESS; 3�3.t ty1 CITYISTATEIZIP: <br /> 2 <br /> PHONE(1): qjQ-C>14f, PHONE(2): nR) 7zt- ,A4, FACSIMILE: 90t. r(to- e6o'l <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (PIea56 allow 10 business days from date of application submittal-'Tentative only• TIUSt be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REOU T 122 FEE(CASH OR CHECK ONLY)-REQUEST PRO ESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � � I , DATE_ lo4tto <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name City <br /> 1 1ta c -- Uniti <br /> � fll,�tlle �VCK4t ,U F $doh <br /> 2. Ibz ,4 . _Arr�Atu o <br /> 3. p Unil2 <br /> 4. (SZ8 \ \ <br /> 5. --..... Unit 3 )\( <br /> 6. 1V <br /> 7. _, Unh4. <br /> 8. <br /> 9. _... .. ...._. Unh 5 <br /> Specific Date Range of Information Requested: From *6.'" to It 6 <br /> ,,��,,// ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> L±I II DERGROUND TANK(LIST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT OLID WASTE FACILITYNENICLE <br /> L�D3 ER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY E TIRE <br /> �'[) ERGROUND TANK(MONITORINGIREMOVAL) DOG KENNEL <br /> ARDOUS WASTE GENERATOR Y <br /> ❑CHICKEN RANCH A TEWA7ER TREATMENT PLANT <br /> L-fTIERED PERMRfIE FACILITY ❑M ELIHOTEL PER TRUCKNARDICHEMICAL TOILETS <br /> rr❑�T��Att00(800V PIERCING PER <br /> ! ND USE APPLICATION SI1T�ESr/�' <br /> G-1hDiCAL WASTE FACILITY Lv(`OTHER(PLEASE SPECIFY) Ah� t'Lcorala o !r<v�roKntCwrogL� covlc[r`t. <br /> WELL ANP SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OVPM(EXCLUDING HOLIDAYS) <br /> 1. List un to ten addressee 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. F 2 4 d- 1 r Indicated above Address <br /> ranges will not be accepted-for additional esaistance 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 flee that Is actively being worked on by END staff may not be immediately available for reew. A new application may be <br /> submitted when the file 18 available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at t s expense of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> Cao use oNLr <br /> END 0410 <br /> 0>/r9/10 <br /> l00/LOOo <br /> XVj EB LO ILOZ/Z01LL <br />