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1234 KLEINFELDER 17.23:28 02-18-2010 1 /1 <br /> DATE RECEIVED i EHD LOG NUMBER <br /> E C � N DD ENVIRONMENTAL HEALT <br /> UH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> FEB 1 9 ,Z-0'0 Telephone: (209)468-3420 Fax: (209)464-� 138 Web:www.sjgov.org/eh <br /> ENVIRONMENT HEATH PUBLIC RECORDS RELEASE APPLICATION <br /> PERM ITS BUSINESSIAGENCY: (1 <br /> ADDRESS: <br /> PHONE(1I: HCl)I X77-q 333 PHONE(2): FACSIMILE: V V f 675 3y� <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow ten business days frLa] <br /> 'cation sublhittal-'Tentative only-must be confirmed) <br /> 0 CHECK BOX TQ EXPEDITE REQUEST-$98.00 CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> --Street-# Street Name City ❑Unit 1 <br /> a <br /> 2. 1 - - <br /> l7 Unit 2 <br /> 3. <br /> 4. Unit 3 <br /> 5. <br /> li tr <br /> nit4 <br /> 7. <br /> 8. <br /> 9. <br /> nit 5 <br /> t0• 0 Unit <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ZO"UNDERGROUNO TANK(UST)CLEANUP SITE(LOP) ❑HOUSING A9ATEMENT ❑SOLID WASTE FACILmf1VEHICLE <br /> o;MTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY Q WASTE TIRE <br /> J'QNDERGROUND TANK(MONITOWNGIREMOVAL) ❑DOG KENNEL 0 DAIRY <br /> ,O'AA2ARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ©TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TArTODIBORY PIERCING ❑POOLISPA 13 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAT-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(2091464-0138 or mail to the above addres . Address ranges will <br /> not be accepted-for additional assistance with file addresses,Contact the EHD. Applications received after 3:00 pm will <br /> 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 <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 the EHD staff may not be immediately available for review. A new application <br /> may be 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 49-06 70/)9107 <br /> PUBLIC RECDRDS RELEASE APP FORM <br />