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SAN JOAQUIN COUNTY EHD LCc'NUMBER <br /> UtL; 3 0 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, 3029 2 <br /> EfdVfRONft4ENTHEALTH Telephone: (209) 468-3420 Fax: (209) 464-0101 368 Web:Web: www.sjgov.org/e d J <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: MATT SMALLEY <br /> BUSINESSIAGENCY; PELTA <br /> ADDRESS: 724 VALLECO WAY —�--- <br /> CITYISTATE2IP; SACRAMENTO <br /> PHONE(1): 916 446 3803 PHONE (2): FACSIMILE: 916 638 8385 <br /> TENTAT/VE`APPOINTMENT DATE: <br /> (Please allow 10 business days from date oto licalion submittal-• TIME: <br /> PP rentative only.most be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$11 EE( H Oft CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /2 <br /> DATE—1 Z- 1—(1 <br /> Electronic Information: (]List LJ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street III Street Name City <br /> 1. 610 0 HWY 99 NTH — STOCKTON <br /> 2. 1617 FREMONT W STOCKTON \ <br /> 3. 3212 CALIFORNIA ST STOCKTON U­t2 <br /> 4. 16470 CAMBRIDGE DRIVE LATHROP \ <br /> 5. 3978 HWY 99 STH L <br /> STOCKTON Jr.IF <br /> 6. <br /> 7. <br /> 8. <br /> 9, Uni15 <br /> Specific Date Range of Information Requested: From ALL to PRESENT <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> El OTHER CLEANUP SITE(NON-LOP) E]SOLID WASTE FgCILITYNENICLE <br /> ❑FOOD FACILITY 0 WgSTE TIRE <br /> ®UNDERGROUND TANK(MONITORINClREMOVAL) ❑D00 KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR ©CHICKEN RANCH <br /> ®TIERED PERMITTED FACILITY Ej MOTELIHOTEL ❑4VA8TEWATER TREATMENT PLANT <br /> ❑TATTOOIBODY PIERCING❑ ❑PEl[IPUMPER TRUCKIYARDICHEMICAL TOILETS <br /> OOLISPq LAND USE APPLICATION SITES MEDICAL WASTE FACILITY El OTHER(PLEASESPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uP to ben addresses In the$Pace above. Select the type($)of files from the list above b checkin the appropriate <br /> box(es). At least one 1110 type MUST be selected. Fa to 081 484.0735 or mail to the address Indicated aboeAddress <br /> ranges will not be accepted-for additional assistance with 1110 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 behold 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 at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> 8. It you neea further assistance, please contact Diane Martinez,at(209)468.3426. <br /> ENO OSE ONLY <br /> EHD d8-OB <br /> erl>ro9 <br />