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1234 KLEINFELDER 21:12 09-24-2010 1l1 <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> n SRD EC <br /> \I ED ENVIRONMENTAL HEALTH DEPARTMENT <br /> SEP ` 4 [010 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIRuNlvatNj HEALTH Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 4BUSINESS/AGENCY: n <br /> ADDRESS: 121 (o CITYISTATE/ZIP: <br /> ��3� <br /> PHONE (1): �� 5�1. PHONE (2): FACSIMILE: <br /> TENTATIVE'APPOINTMENT DAT Time: <br /> (Please allow 10 business days ft i date of applic ion submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- 12 F E(CASH 0 CHECK O Y)-REQUEST PROCESSED IN 3 BUSINES DAYS <br /> SIGNATURE OF APPLICANT DATE 9 23 a <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> 2. <br /> i___ -_----- — <br /> [I Unit 2 <br /> 3. <br /> 4. <br /> - --- XUnit3 <br /> 6. li6nit 4 y <br /> 7. <br /> 8. <br /> — --- - --- - ❑Unit 5 <br /> 9. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> r ENVIRONMENTAL HEALTH DEPARTMENT FILES J �►,/�/I/ <br /> �NPERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT3 z <br /> ❑SOLID WASTE FACILITYNEHICLE ✓ ,/�j <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> gt NDERGROUND TANK(MONITORINGIREMOVALDOG KENNEL ❑DAIRY 1 1 <br /> ❑HAZARDOUS WASTE GENERATOR_,7\ \ ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS �I <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List 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 be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance 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 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 USE ONLY <br /> -a 0: t7� 4:1�2 1 ,n � 6 r.,G q-za-t0 <br /> EHD 48-06 <br /> 07/29/70 <br />