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U°ERVED E0 SAN JOAQUIN COUNTY <br /> NERVED . . iRONMENTAL HEALTH DEPARTMENT <br /> UEC 2 7 2010 600 East Main St. Stockton, CA 95202-3029 7 <br /> g$ <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENPFE T/sERWES H PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/SERVFCES <br /> APPLICANT: ga�r,'i )p'-�L BUSINESS/AGENCY: IEZ fik <br /> ADDRESS: 799r 'r �L-,F—VAgD CITY/STATE/ZIP: 4/ e_Le"r C;q <br /> PHONE (1): PHONE (2 • FACSIMILE: fjl�_ A/ <br /> TENTATIVE'APPOINTMENT DATE: 41_i1_1( Time: 1.. '36 <br /> (Please allow 10 business days from date M application submittal•'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST• CA HEC REQUEST PROCESSED IN 3 BUST SS D S <br /> SIGNATURE OF APPLICANT DATE /� /!� <br /> Electronic Information: ❑ List ❑ Map— Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> ❑Unit 1 <br /> 1 D d Dir✓€ S d�-f—,ffl <br /> 2. <br /> Unit 2 <br /> 3. \\ <br /> 4. Unit 3 kkTkIll <br /> 5. <br /> 6. <br /> T Unit 4 <br /> 8. <br /> g ❑ Unit 6 <br /> 10. <br /> ❑ Unit 8 <br /> Specific Date Range of Information Requested: From to <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT FILES .X a1 v pyW <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT t" <br /> OTHER CLEANUP SITE(NON-LOP) ElFOOD FACILITY SOLID WASTE FACILfTYNEHICLE <br /> ElWASTE TIRE i�z/ IIll <br /> �g]UNDERGROUND TANK(MONITORING/REMOVAL)f,,, ❑D00 KENNEL [I DAIRY <br /> I®HAZARDOUS WASTE GENERATOR V� ❑CHICKEN RANCH❑ ISL- <br /> ❑WASTEWATER TREATMENT PUNT <br /> TIERED PERMITTED FACILITY <br /> ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTDOBODY 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(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 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 flies 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 retumed 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$115 deposit prior to review. <br /> 5. If you need further assistance, please contact Diane Martinez,at(209)468-3425. <br /> I a� ) EHD USE ONLY <br /> ( u,17� e <br /> W I `7 ) d <br /> FYfI I.J1� <br />