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11 U L�I1WE Q EHD LOG NUMBER <br /> u U ILJI� SAN JOA UIN COUNTY , <br /> E?�' IRONMENTAL HEALTH DEPARTMENT r <br /> NOV j $ 2008 600 East Main St. Stockton, CA 95202-27081 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLICIA , ,RECORDS RELEASE APPLICATION <br /> APPLICANT: Zf�1 (✓L— -0/J ✓v V l BUSINESSIAGENCY: /�n <br /> ADDRESS: _ O I C Fitt,- 22-1 L✓ C'3)CITYISTATEIZIP SMC.I 7V'#� U�U4/. ////�S <br /> PHONE(1): a 9 Z9 E-—3.�O PHONE(2): FACSIMILE: !/570/- 73S F06? <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST,005.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT - DATE <br /> Electronic Information: ❑ List❑ Map-De .ription: <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name city ❑ Unit 1 <br /> ,Y- 1 3oll 10, 147v&7- bK Jl­ s <br /> 2. ❑ Unit 2 <br /> 3. <br /> 4 Unit 3 <br /> 5. Ole <br /> 6 Unit 4 <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> ❑ unit s <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES (�fS <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT C3 SOLD WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY t7 WASTETIRE <br /> UNDERGROUND TANK(MOMTORINGIREMOVAL)Obi ❑ DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR 0(_ C3CHICKEN RANCH 13WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FAcIL1T10C O MOTELIHOTEL 17 PUMPER TRUCKIYARD/CHEM TOILETS <br /> TATTOOBODY PIERCING ❑ POOLfSPA 0 LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-S:OOPM - 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$105.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance please contact Diane Martinez C (209)468-3425 directly. Thank You*** <br />