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V0 11/GUU-4 nUN IJ: 4y r"Ax ZU94bbZY9! SJC Public works 0001/001 <br /> C�ED; <br /> '~ EHD LOG NUMBER <br /> � SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> i AUG 1 7 2009 600 East Main St. Stockton, CA 95202-2708 <br /> E�� I t4pr lk �� g phone; (209) 468-3420 Fax: (209) 464-0138 Wets: www.sjgov.org <br /> '�!:�MIVICES►t PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: { -a i, /tee- BUSINESSIAGENCY:V' t X10 UiVt � 11UWr� ted <br /> ADDRESS: �b IO 5, SIA CITYISTATEIZIP: &Ucufu•" ' cx'} �O�l <br /> i <br /> PHONE (1): 4qU -- ��� PHONE(2): FACSIMILE: �� - j�fq <br /> TENTATIVE*APPOINTMENT DATE: Time: J <br /> (Please allow 14 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$115.CO FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> i <br /> SIGNATURE OF APPLICANT _O, DATE <br /> Electronic Information: ❑ List❑ Mapj-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> 2• SSD1, Grp L; 12d• �a�d _ Unit 2 <br /> 3• 3l rangy r!,i12d. �n�_ ---- ��" <br /> 4• SZ&q Vy. <br /> irant Li�1- e RA &niz,, nit 3 <br /> 5- a 3?n S. l nc 4io cu►#�. - <br /> nit 4 <br /> 7. SSKI VV. 61 ra n 4- L,4 e BaniA_ <br /> 8. SS 3 a- I W, rml�- L'+v e- f)"Lka, ❑Unit 5 <br /> 9. 9;t4 B(9 { 'S. s i oA s+. <br /> 10. � ! W• - ❑Unit s <br /> I Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> C�INDERGROUND TANK(LIST)CLEANUP SITE(LOP) �OUS€NG ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> c gDTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> �INDERGROUND TANK(MONITOR(NGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> C&HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FAC€LITY ❑MOTELIHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ! ❑TATTOOIBODY PIERCING ❑PCOLISPA AND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑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 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 /> I 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 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$115.00 deposit prior to review. <br /> EHD U5£ONLY <br /> ***If you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You' <br /> �ia�r�nno <br />