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1234 KLEINFELDER "21:12 09-24-2010 111 <br /> �(`DATERECEIVED ,yam SAN JOAQUIN COUNTY � EHD LOG NUMBER <br /> RES \l EV ENVIRONMENTAL HEALTH DEPARTMENT W� <br /> SEP $ 4 2010 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRUNIv1tIUT HEALTH MACES PUBLIC RECORDS RELEASE APPLICATION <br /> �� <br /> PERMIT <br /> APPLICANT: /(sq BUSINESS/AGENCY: _ <br /> ADDRESS: n CITY/STATEIZIP: \ &P-'E6 <br /> PHONE(l): �� �_I (-�S3 V PHONE(2): FACSIMILE: <br /> TENTATIVE'APPOINTMENT DAT ime: <br /> (Please allow 10 business days date of applic ion submittal•'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST- 12 RIE(CASH 0 CHECK O Y)•REQUEST PROCESSED IN 3 BUSINES DAYS <br /> SIGNATURE OF APPLICANT DATE 9 O a4� <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name City <br /> _ Unit1 <br /> AJO 5� <br /> 2. <br /> ❑Unit z <br /> 3. <br /> 4. <br /> Unit 3 <br /> S. --- 1/ <br /> 6. N nit 4 7 <br /> T. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> ,0. _- <br /> ❑unit s <br /> Specific Date Range of Information Requested: From to �! <br /> ,��,,,,�,*''•� ENVIRONMENTAL HEALTH DEPARTMENT FILES J kI <br /> L7uN RGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE 3h <br /> R CLEANUP SITE(NON-LOP) , ❑FOOD FACILITY E]WASTE TIRE k3. 0 <br /> NDERGROUND TANK(MONRORINGIREMOVALY/t ❑DOG KENNEL [I DAIRY UII <br /> ❑HAZARDOUS WASTE GENERATOR 00\ - \ ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT ;q-1 O <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOBODY 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(E%CLUDING HOLIDAYS) <br /> 1. List un to ten addresses in the space above. Select the type(s)of riles 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 /> O% <br /> EHD 48-06 01129110 <br />