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08/12/2005 08:23 9252741103 ARCADIS $0504 P.002/003 <br />u U <br />� �E, �.. SAN .IOAQUIN COUNTY �ftw EHD LOG NUMBER <br />AUG 12 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-2708 <br />�NpE MITIS' 6EN- &lephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd _3 <br />PUBLIC RECORDS RELEASE APPLICATION <br />ADDRESS: <br />,INESSIAGENCY: %�CY�U1S <br />CITYISTATE/23P: walnut CAiBhr CA q#996 <br />PHONE (1): �f, /p� `�(�5� Som 1 / PHONE (2)FACSIMILE: <br />TENTATIVE" APPOINTMENT DATE: gf 1r�L7� Time: /O:Od AM <br />(Please allow 10 business days from date of epPllcadon subndttai.'Tentative only - must be cony= <br />JR CHECK BOX TO EXPEDITE REQUEST - $115.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BV sr, Ryf <br />SIGNATURE OF APPLICANT DATE S <br />Specific Date Range of Information Requested; From (85-0 to A L Z) <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT FAGLTYNEHI V <br />X] <br />OTHER CLEANUP Sn (NON -LOP) [] FOOD FACILITY a e�,rrASTE TIRE � �1J. ?, , <br />1UNDERrRQuNo TANK (Mtxi ra dNcIREMovaL) ❑ Doc El DAIRY 1 <br />HAZARDOUS WASTE GENERATOR o(, ❑CHI WASTEWATER TREATMENT PLANT <br />N TIERED PERMITTED FACILTTYQ( ❑MOT L BPUMPERTRUCKIYARDICHEmicALToi 't<. g/(75fE <br />TATTOOBODY PIERCING d P A LAND USE APPLICATION SrrEs <br />MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REy1EW MONDAY -FRIDAY 5:00 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 Tile 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 tate expense of the applicant <br />Future file reviews by the same applicant may require a $11S.00 deposit prior to review. <br />MONO �� <br />AN <br />.L..._i!I /i ' .i u h ., / � � A ... ) ..' • ice' A. / <br />FILffADDRESSa <br />SWOW Name <br />I V ! <br />r w <br />��1V <br />'llfll <br />r <br />■ <br />r. _�. <br />r <br />['ave ^ <br />�.?�h��it ■ <br />III <br />' + <br />� <br />� <br />Specific Date Range of Information Requested; From (85-0 to A L Z) <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT FAGLTYNEHI V <br />X] <br />OTHER CLEANUP Sn (NON -LOP) [] FOOD FACILITY a e�,rrASTE TIRE � �1J. ?, , <br />1UNDERrRQuNo TANK (Mtxi ra dNcIREMovaL) ❑ Doc El DAIRY 1 <br />HAZARDOUS WASTE GENERATOR o(, ❑CHI WASTEWATER TREATMENT PLANT <br />N TIERED PERMITTED FACILTTYQ( ❑MOT L BPUMPERTRUCKIYARDICHEmicALToi 't<. g/(75fE <br />TATTOOBODY PIERCING d P A LAND USE APPLICATION SrrEs <br />MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REy1EW MONDAY -FRIDAY 5:00 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 Tile 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 tate expense of the applicant <br />Future file reviews by the same applicant may require a $11S.00 deposit prior to review. <br />MONO �� <br />AN <br />.L..._i!I /i ' .i u h ., / � � A ... ) ..' • ice' A. / <br />