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rrApr, 19, jj2��011011 :20AM Uncon Consultants, Inc, No, 7000 P. 1 <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> 9;-12 1 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> ENVIRONNitiv i HEAtt"hone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.or <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: qV2� BUSINESSIAGENCYt Ii�,n ` <br /> ADDRESS: ��0 \{��oFC_, s CITY/STATE/ZIP: l�t°dltL✓LL_ . � F� c/3r_p <br /> PHONE(1): -(Dy( - I Opp PHONE(2): FACSIMILE: 0r <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow ie business days from date of opp"l lion submittal-•Tentative only-must be confirmed) - <br /> ❑CHECK BOX TO EXPEDITE RE EST-$115 F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE I/Ia <br /> Electronic Information: 0 List C1 Map-Description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street A Street Name <br /> City <br /> 1. 2c�U _7. ln/�0., 0�TO Z L i Unit 1 <br /> 2 V�Oti J <br /> 3. ----'0 Umt z <br /> 4. <br /> B. <br /> 7. 0I nita <br /> — <br /> r— <br /> ' ✓�J� ❑Unit$ <br /> 9. <br /> 10. <br /> El Unit s <br /> Specific pate Range of Information Requested: from <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES to <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) EJ HOUSING ABATEMENT ❑SOLID WASTE FACILItYNEHICLE I n U <br /> OTHER CLEANUP SITE(NON-LOP) p FOOD FACILITY ❑WASTE TIRE <br /> NDERORQUND TANK(MONrTORINO/REMOVAL) E]DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT 11 ,.,,,^� <br /> ❑❑ Y ❑ <br /> TIERED PERMITTED FACILITY ❑PUMPER TRUCKNARDICHEMICAL TOILETir{//I <br /> TATTOO/BODY PIERCING ❑POOLI$PA ❑LAND USE APPLICATION SrrES <br /> F-1 MEDIC /MEDICAL WASTE FACILITY El OTHER OTHER(PLEASE SPECIFY) ! "( l z/p b <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00pM(EXCLUDING HOLIDAYS) <br /> 1. L(sl u to ten dresses In the space above. Select the type($)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464 138 or mall 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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)488.3425. <br /> EHD USE ONLY <br /> - L / l <br /> / c. <br /> EHD"9 06 <br /> 011TI09 <br />