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RECEIVED EHD LOG NUMBE <br /> SAN JOAQUIN COUNTY <br /> NOV 0 2 2011 EWVIRONMENTAL HEALTH DEPARTMiJT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ 6,A Wot*, BUSINESSIAGLNCY: Cy1e.�,,� s♦ , <br /> ADDRESS: 3� { W 'Q'Z6 C CITY/STATE/ZIP: 5, CSA 'mzl <br /> PHONE(1): (9t�� `rte- oz-3b PHONE(2): (3 -7t- 5tA4 _ FACSIMILE:Cgtb x{80- oboe <br /> TEN ATI E APPOINTMENT DATE: Time: <br /> (please allow 10 business days from date of applycation submltWf-'Tentet,ve only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REOU T 122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSEIJ IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ta(?t'tr <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street A Street Name City <br /> - Unit 1 <br /> 2- I b� Apt o <br /> �.hQ <br /> 3. 2$at unit2 <br /> 02 9� ,-2- ?J :5 <br /> 4. units ll� <br /> S. ,v <br /> 6. <br /> 7. - Unit 4 <br /> 10. <br /> Specific Date Rango of Information Rsqusstrd: "- <br /> Unit 8 <br /> From AL-k. to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �DERGROUNO TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT E?,�/ <br /> �FtER CLEANUP SITE(NON-LOP) L'f bpLID WASTE FACILfTYIVEHICLE <br /> FIERZ <br /> ❑FOOD FACILITY ( }1G/US7E TIRE <br /> ERGROUND TANK(MONITORINGIREMOVAL) �DOG KENNELMA <br /> "ARDOUS WASTE GENERATOR Y❑CHICKEN RANCH TEWATER TREATMENT PLANT <br /> Ll PERMITTED FACILITY ❑M EL/HOTEL PER TRUCK/YARO/CHEMICAL TOILETS <br /> 9-`16TT00/BOASOY PIERCING Qom, OOL/SPA AND USE APPLICATION SITES <br /> t mEDiCAI WASTE FACILITY L✓1pTHER(PLEASE SPECIFY) AA-1 y <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-SO�PM(EXCLUDING IDA$) cr~ <br /> 1. _L_Ist 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 W selected. Fax to(209)464-0138 or <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications receiveadd rs <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 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 DSE ONLY <br /> EHD 48 OB <br /> 07/29110 <br /> 100/100 ] <br /> Xvi EZ LO 1102/ZO/ll <br />