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NOV-02-2009 01 : 15 PM 23553. 56637 559 992 4954 P. 02 <br /> RE(ragvEn LOG NUMBLR <br /> SAN JOAQUIN COUNTY <br /> NOV 2 2009 ENVIRONMENTAL HEALTH DEPARTMENT' <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> E"RONWNT HEALTH Telephone: (209)468-3420 Fax, (209)464-0138 Web: www,,oAjqov,org <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> _..__PUSINESSIAGENCY, <br /> ADDRESS: <br /> CITY/STATEIZIP: <br /> PHONE(1): 16) ----i 5..J J01 b PHONE (2): FACSIMI(.E,, Sle, <br /> ,.N7*ATIVE'APPOIN'T'MF--,',NTL)A'I"E. Time� <br /> (Ploase allow 10 business days from date of application submittal-11entative only-must be confirmed <br /> 5115 FEE: "A 1 OR CHEEK DWY) IN 3 BUSINESS DAYS <br /> 5IGNATUREOF APPLICANT DATE. <br /> =Eloctronic Information: List Map— De"'acription: <br /> FILE ADDRESS EHI)USE ONLY <br /> street 0 Street Name City Q Unit i <br /> CA r4zc <br /> 2. ly <br /> oft 2 <br /> 3. <br /> 4- <br /> 4. <br /> Unit 3 <br /> 5. <br /> 6. <br /> UnIt.4 <br /> 7. <br /> Unit 6 <br /> / nit 61 <br /> Specific Data Range of Information Requested; From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> :-.. UNDLRGROLINDTANK( <br /> USn CAXAN <br /> UP SITE(LOP) , HOU%INCABAT <br /> F.MENT OL <br /> ID <br /> WAST <br /> E,FACILITYIVEHIC11N' <br /> O <br /> W <br /> FTH[R ClCANUP SITE(NUN-LOP) FOOD FAC1-1Y WASTE TIRr <br /> IN91-kGROUNo TANK(MoNriORINGIREMOVAI.) DocKLNNF.I.. [JPAIRY <br /> 17AZARDOUS WAST!GrNrRATOR CHICKFNRANCH WASTEWAMTRFA WENT PLA91Ej F(. llRtl)PERMITTED FACILITY MOTFLIHOTEL j PUMPER TRUCKIYARDICHEMICALTOILETS <br /> [1TATT00/30DY PIERCING POOLISPA r�AND <br /> USE APPLICATION SITF.5 <br /> MEDICALIAIAS11JACILITY OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am.5:00PNI_(EXCLUDING HOLIDAYS) <br /> 1, j=LsLq0 to ten lddresses,In the space above. Select the type(5)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091 464-Ql 38 gEmall j2AhLj=0j Ing1jililld AbOV9. Address <br /> ranps YOU 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 EHO files exist. An appointment for review will bo confirmed approximately ten 0 0) <br /> days after receipt of application. The files will be held for a maximum of fiv(P business days for review. Appointments <br /> vhould be scheduled accordingly. <br /> 3. A file that Is actively being worked on by EHO otaff 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 EHO staff at the expense of the applicant, <br /> Future file reviews by the same applicant may require a$1118 deposit prior to review, <br /> S. if you need further Pamistanco,ploane contact Diane Martinez,at(209)468..3426 <br /> EHO Urt ONLY <br />