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FROM = JODI VRNNEMRN • FAX NO. : 4154793988 Oct. 08 2010 10:47AM P2 <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> UU ��LL�� UU 11JJ ENVIRONMENTAL HEALTH DEPARTMENTIF77 <br /> UC f 0 8 2010 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.oreh <br /> ENVIRUNIVILNI HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> P APPLICANT= BUSINESS/AGENCY: <br /> ADDRESS: '%4A1L �_ CITY/STATEIZIP: Q �1 i <br /> PHONE(1): Z o ap �I%RHONE(2):3q,2!5 �� FACSIMILE: 03' <br /> TENTATIVE"APP INTM NT DATE Time: <br /> (Please allow 10 business days fromdate of application submittal- TentadVe Only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST•$122 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit i <br /> - r � � <br /> ,IW _- nit 2 <br /> fV 1 <br /> 4. <br /> 7. <br /> 8• LL:j <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> �—y� ENVIRONMENTAL HEALTH DEPARTMENT FILES T-.. <br /> .,FO NDFRGROIIND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLIO WASTE FACILITYNEHICI.F <br /> O/ OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> OpPONDERGROUND TANK(MONITORINGIREMOVAL)p<_ El DOG KENNEL (]DAIRY <br /> HAZARDOUS WASTE GENERATOR ED CHICKEN RANCHASTEWATER TREATMENT PLANT <br /> �IERED PERMITTED FACILITY ❑MOTELIHOTEL �UMPER TRUCKIYAROCHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> [] MEDICAL.WASTE FACT!TY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REvIEw: MONDAY-FRIDAY 8:00 AMS:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten adds <br /> reses 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 END. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any END 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 /> sHn sE ou�v <br /> a <br /> EHD 49-06 07@9/1D <br />