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aqu11i county –> 4640138 <br /> 2 <br /> 6�T <br /> `JU SAN JOAQUIN COUNTY EHD LOO NUMBER <br /> wuV 'All 0 2009 ENVIRONMENTAL HEALTH DEPARTMENT +100- <br /> 600 East Main St.Stockton,CA 95202-3029 <br /> ENVtRmu,ENT HEALTT?Iephone: (209)468-3420 Fax: (209)464-0138 Web:www,sjgov.org/e <br /> PERM1(T/SEP,VICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT D6 aR it BUSINESSIAGENCY: A S r <br /> ADDRESS: ¢q- N . 5��, Te CITY/STATE/ZIP., <br /> PHONE(1):62oq) PHONE2 <br /> ( ) FACSIMILE: (,�cxr) 944,g ST s <br /> TENTATIVE*APPOINTMENT DATE: 1}e C 4- ao Time: – <br /> (Please allow 10 business days"w'" —uor applica ion submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQI�STT-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 1,V DATE ao V j 9, ayo y <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS F USE ONLY <br /> Street# Street Name APP City <br /> ❑Unit 1 <br /> 1' a70 c , a e1-i - !e-• 5roc:Kronl <br /> 2' �13� nl- •oto ;i� -57 <br /> Unit23' a�45-00-14' - A•1i Loe r oen3 to5' 3s p Lo�75. O� 10 1 L p J <br /> 7, <br /> 8. <br /> 9 ❑Unit 5 <br /> 10. <br /> ❑Unit a <br /> SpeZ Date Range of information Requested: From i I I/;t000 to t'u N 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHiCLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINOIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUSWASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MOTELIMOTEL <br /> TATTOOiIBODYPIERCING POOUSPA ❑PUMPERTRUCKIAROITES <br /> SALTOILETS <br /> MEDICAL.WASTE FACILITY ❑LAND USE APPLKCK) <br /> ATN SITES <br /> []OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1, List un to ten addresses 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(20)404-0138 or mail to the address Indlcated shove 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(Iles exist, An appointment for roview will be confirmed approximately ten(10) <br /> days after receipt of oppilcatlon. The flies 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 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 /> 6. if you need further assistance,please contact Diane Martinez,at(209)488.3426, <br /> END USE ONLY <br /> END�!-01 <br /> 1127109 <br />