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MAR-16-2010 TUE 02:49 PM H M H FAX N0, 916 383 6014 P. 01/01 <br /> [EC VI <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> MAR 1 s 201 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIROWEN1 NEALTH Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov. ZC3 <br /> PERMIT SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: RYNO USINESS/AGENCY:#Nlf &4>ZRS /NC- <br /> ADDRESS: /S wEcS CITY/STATE/ZIP; Tn <br /> PHONE(1): !4) W �zsra PHONE(2)&16) 386 - 7l((P C'� �8�8 <br /> FACSIMILE: /4�� s - e 1t4 <br /> TENTATIVE•APPOINTMENTDATE: 3 3/'20/[ <br /> (Please allow 10 t uslriess days from date of application submittal-•YeMatim onl Time: /.'o <br /> y-must ho <br /> ❑CHECK Bconfirmed) <br /> OX TO EXPEDITE REQUEST- 15 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 3 !G 20/0 <br /> Electronic Information: ❑ List Map—Description: <br /> FILE ADDRESS EHO USE ONLY <br /> Street 6 Street Namo - <br /> city <br /> _1' rJZS ,qG <br /> IN S'T&EE'r ~J7CGL.h>N Un 1 <br /> 2. <br /> 3, Unit <br /> pV(V 4. N" <br /> S. <br /> 7. Unit 4 <br /> 8. <br /> 9, Unit S <br /> 10. <br /> SpeclNc Date Range of Information Requested; From to Q Unit 6 <br /> 11tt��I <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> R7 <br /> UNDERGROUNO TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILrIYNEHICLE <br /> ❑ !,1 <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE J J'IN 2 <br /> IUNDERGROUNOTANK(MONtFORING/REMOVAL)X_ ❑DOGKENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOROC ❑CHICKEN RANCH E]WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITV ❑MOTELIHOTEL ❑PUMPERTRUCKIYARDICHEMICALTOILETS <br /> ❑TATTOOBODY PIERCING L].POOL/SPA ❑IAND USE APPLICAMN SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPEce Y) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-E:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uo to ten addresses in the space above, Select the type(s)of files from the list above by checking the appropriate <br /> 90X(es). At(east one file type MUST be selected. Fax to(2091484.0138 or mall to 0+a address Indicated above Address <br /> ranges will not be accepted-for additional assistance with Ble 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 tan(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$115 deposit prior to review. <br /> S. If you nood further assistance,please contact Diane Martinez,at(209)468.3425. <br /> EMO USE ONLY <br /> -a fir- • � � �I <br /> EHb b-06 <br /> efl7pa <br />