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IRONMENTAL HEA!_TH DEPARTmr7r <br /> NOV 0 X600 East Main St. Stockton, CA 55202-3026..— <br /> Telephone: (209)468-3420 Fax: (209)464-6138 Web: www.sjgav,org/ehd <br /> ENVIRONMENTAL HEALTH 09\ <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ?Art" BUSINESSIAGENCY. <br /> ADDRESS: '-jp'k'y( M--� AW.AW <&A& CITYISTATEaIP: Z <br /> PHONE(l): f qp �, PHONE(2): '�o Z a !84o FACSIMILE: qtb to- cbti3 <br /> TENYATI E'APPOINTMENTDATE: Time: <br /> (Pinata allow 10 business days from date of application sub ittaf-•TentB#vo only-must be conflrmea) <br /> ❑CHECK BOX TO EXPEDITE REDU T 122 FEE(CASH OR CHECK ONLY)-REOUEST PROCESSED IN 3 13USINESS DAYS <br /> SIGNATURE OF APPLICANT DATE to t f <br /> Electronic Information: ❑ List 0 Map-Descrlptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> _ r y _... Unit f <br /> Street i! Street Name Cit <br /> �• �� k Ali �kQ <br /> 2. lbz <br /> 3. xt p tlnitz <br /> 4. <br /> $. - . .. Unit S <br /> �. — - - Unit 4 <br /> 9. Unit 5 <br /> 90. <br /> Unit 8 <br /> Spa cdic Data Ranga of information Requested: From _AL.JL.. to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ,�� <br /> [� ERGRbUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT L �pLln WASTE FACILfTYIUEHICLE <br /> V) ER CLEANUP SITE(NON-IAP) ❑FOOD FACILITY RIR F TIRE <br /> FERGROUNO TANK(MONITORINGIREMOVAL) ❑DOG KENNEL y <br /> ARDOUS WASTE GENERATOR ❑CHICKEN RANCH [� A TEWATER TREATMENT PLANT <br /> IE�REID PERMITTEp FACILITY ❑M ELIHOTEL pER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TAttO0At30dY PIERCING P LISPALW <br /> AND USE APPLICATION SITES <br /> i1EDICALWASTEFACILffY LKOT}IER(PLEASESPECf Y) A,% Iylco4s pi] enrnm►tw�lw� Cov geld. <br /> WELL AND SEPTIC PERMIT RECORDS Ai?! AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-$:0&m(EXCLUDING HOLIDAYS) <br /> f. List up to ten add sea 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 209)464-t11H or mall 12 the addresa"Inol,_oated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHb. 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 appointmei tfor review will be confirmed approximately <br /> days after receipt of application. The files will be held for a maximum of fire business days for review. Appoi tmets(10) <br /> should'be scheduled accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not b <br /> submitted when the file Ia available. e immediately available for review. Anew application may be <br /> 4. Any Elle 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 /> i <br /> etlD use oNw <br /> EHD 48-0e <br /> Of/P4N0 <br /> 100/L0019 <br /> XVj EE:ZO 110Z/Z0/1L <br />