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Nov 12 2009 5: 13PM HP LASERJET FAX P. 1 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN .JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.or <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �yJl� Lid BUSINESSIAGENCY: lG p <br /> ADDRESS: ��_W <br /> CITYISTATEIZIP: — <br /> PHONE (1):(1R�"l` 11 PHONE(2): FACSIMILE.. (O <br /> TENTATIVE'APPOINTMENT DATE' Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE RE S - 115 F - Ci25H 0 HE K ONLY)-REQUEST PROCESSED IN 3180 (NESS DAY <br /> SIGNATURE OF APPLICANT K, DATE 1 <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street if Street Namo City U 'L� ❑Unit 1 <br /> t1 <br /> 2. --- - <br /> OU . <br /> 3. <br /> 4 nits <br /> 5. <br /> 6 nit <br /> 7. -_ <br /> 8. - - — - — ❑Unit 5 <br /> 9.10. <br /> ❑Unit6 <br /> Specific Date Range of Information Requested: From _ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILrrYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(NIONITORINGIREmovm.� ❑DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATERTREATMENT PLANT ( 1 <br /> ❑TIERED PERMITTED FAGLITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY RERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> L I MEDICAL.WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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 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)468-3425. <br /> EHD USE OVLY <br /> ---- - - M7/09 <br /> E H D 48-06 <br />