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1234 KLEINFELDER 17:23:28 02-1B-2010 1/1 <br />j� rte— j��6 � I��yE���� <br />i �((r'�cI,�I7 II 11 SAN JOAQUIN COUNTY EHO LOG NUMBER <br />11 lll�vl�ll VV t�� ENVIRONMENTAL HEALTH DEPARTMENT <br />FEB 1 9 2010 600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.Org/eh nj <br />ENVIRONMENT HEALTH PUBLIC <br />PERMIT/Milli FS RECORDS RELEASE APPLICATION <br />O <br />APPLICANT: <br />ADDRESS: <br />PHONE (1): _ <br />PHONE (2): <br />TENTATIVE' APPOINTMENT DATE: Tim: <br />(Please allow ten business days fro app cation submittal m <br />l - 'Tentative only • must be con8retl) <br />CHECK BOX TO EXPEDITE REQUEST • $98.00 E (LASH CHECK ONLY) - REQUEST PROCESSED IN THREE BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE a11R1.1810 <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS EHD USE ONLY <br />1. <br />Street p <br />Street Name <br />City <br />O unit 1 <br />,!QQ <br />SOLID WASTE FACIL <br />m'IVEHICLEFOOD <br />�. <br />2. <br />❑FACILITY <br />0 DOG KENNEL <br />❑WASTE TIRE <br />O <br />l <br />Ind O Unit 2 <br />Unit 3 <br />3. <br />4. <br />jt= <br />C <br />,21HAZARDOUS WASTE GENERATOR(` <br />0 TIERED PERMITTED FACILITY <br />6. <br />O WASTEWATER TREATMENT PLANT <br />0 TATTOOIBOOY PIERCING <br />6. <br />_ <br />0 MEDICAL WASTE FACILITY <br />nit 4 <br />7. <br />❑ unit s <br />9. <br />10. <br />❑ Unit 6 <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL <br />f <br />HEALTH DEPARTMENT FILES <br />4I-y�I/TANK (UST) CLEANUP SITE (LOP) <br />1313NDERGROUND <br />HOUSING ABATEMENT <br />SOLID WASTE FACIL <br />m'IVEHICLEFOOD <br />�I <br />3��`(� <br />;MTHERCLEANUP SITE(NON-LOP) <br />P%UNDERGROUNO TANK (MONITORINGIREMOVAL)D( <br />❑FACILITY <br />0 DOG KENNEL <br />❑WASTE TIRE <br />O <br />I I✓II1 <br />DAIRY <br />,21HAZARDOUS WASTE GENERATOR(` <br />0 TIERED PERMITTED FACILITY <br />EI CHICKEN RANCH <br />0 MOTELIHOTEL <br />O WASTEWATER TREATMENT PLANT <br />0 TATTOOIBOOY PIERCING <br />0 POOUSPA <br />0 PUMPER TRUCKIYARDICNEM TOILETS <br />0 LAND USE APPLICATION SITES <br />0 MEDICAL WASTE FACILITY <br />0 OTHER (PLEASE SPECIFYI <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS <br />t. List up to ten addresses in the space above. Select the typo(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 ormall to the above address. Address ranges will <br />not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after s ra:00 pm will <br />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 <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 the EHD staff may not be immediately available for review. A new application <br />may be 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 $98.00 deposit prior to review. <br />tHD USE ONLY <br />END aINifi tOIMIaT PUBLIC RECORDS RELEASE APP FORM <br />