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06-01-10; 10: 15 ;916-786-2434 # 1/ 1 <br /> EHD LOG NUMBER <br /> SAN .IOAQU{N COUNTY <br /> 2010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUN 01 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIRONMENT HEAd ephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/e 3 70 <br /> PEgmmSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT. BUSINESSIAGENCY:(f �Qn ����, <br /> ADDRESS: jerov V CITY/STATE/ZIP: lC9C3L1 LAQ cod <br /> PHONE(1): "1 r�n' �� L� PH NE(2): �{(��� p'��{� ACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE:L J (c;[(_0 Time: <br /> (Please allow 1D business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$195 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 14. DATE w t l (O <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name cityl- ❑Unit 1 <br /> 2• ❑Unit 2 <br /> 3. <br /> 4. <br /> nit 3 <br /> 5. <br /> 6. <br /> ent <br /> 7. <br /> 8• I ❑Unit 5 <br /> 9. <br /> 10. nits <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 FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HATARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOL/SPA ❑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 AMS-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 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 atthe 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 ONLY <br /> EHD 48-88 8127109 <br />