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JUL/W2010AED 09: 33 AM 0 . P. 002 <br /> =DIED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> R <br /> u U ENVIRONMENTAL HEALTH DEPARTMENT � <br /> JUL1 4 L010 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.orgehd <br /> ENVIRUNNIFNT HEALTFI <br /> PE r Imo. PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �\\ LY'L..^Yq,Y BUSINESSIAGENCY: , <br /> ADDRESS: J � `�Y\yf �� CITYISTATEIZIP: <br /> PHONE(1):2C)j— PHONE(2): FACSIMILE; <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"7enta6Ve only-must be confirmed)' <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$115 FEE(CASH ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAY <br /> SIGNATURE OF APPLICANT11� DATE r <br /> Electronic Information: L]List❑ Map escription: <br /> FILE ADDRESS EHD USE ONLY <br /> / / Street M Street Name City El Unit 1 <br /> 1. Ivkwi <br /> 2. T <br /> ❑Unit z <br /> 3. <br /> 4' � � � nit 3 n <br /> 6. ( I <br /> 6nit 4 <br /> L1901. <br /> ❑Unit 6 <br /> ❑Unif6 <br /> Specific Date Ronye of Intormation Repuastad: From to OlC� <br /> ENVIRONMENTAL HEAL H DEPART ENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) .❑HOUSING ABATEMENT ❑Souo WASTE FAGLrIYNEHICLE 11 ` <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY - ❑WASTETIRE <br /> UNbERGROUND TANK(MONITORINGIREMOVAO,�< ❑DOG KENNEL ❑DAIRY "43' 0 <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT -7-7040 <br /> r ❑TIEREO PERMITTED FACILITY ❑MOTELIHOTEL ❑n PUMPERTRUCKfYAROICHEMICALT01LET5 <br /> ❑TATTOOIBODY PIERCING POOLISPA r}^ (�,� USE APPLICATION SITES <br /> ❑ MEDICALWASTE FACILITY THER(PLEASE SPECIFY) Lf ,e_r 0T LAC <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 flies from the list above by checking the appropriate <br /> box(as). At least one file Type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges wil(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 FyD will,.nnfiy tt2e Applicant f{Zny,FHD files ex;tf. An app22nfmanf fpr review.will he Onnfirmgrl,a n.eKima4nl�r fen(;1.0) <br /> _per <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 maybe <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 atthe expense of the applicant. <br /> Future file reviews by the same appjicant may require a$115 deposit prior to review. <br /> G. If you need further assistance,please contact Diane Martinez,at(208)488.3426. <br /> EHD Uss ONLY <br /> FH043-Bs <br /> aZIfOB <br />