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1111. ). LVVJ Y.V711f1 ALLIHI LLVLI\ IY V. f7L4 I. I <br /> DATE �E I cHDLv�NUIMBER <br /> ll uEC � V SAN JOAQUIN COUNTY <br /> �1 v �"'Jf VIRONMENTAL HEALTH DEPARTMEA i <br /> NOV Q 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.or <br /> ENV 3 q <br /> p-QUITSEBfiE i PUBLIC RECORDS RELEASE APPLICATION ( ' _1 <br /> P APPLICANT: •��t r BUSINESSIAGE,NCY: jtl�' M'G1C�,{n�-q <br /> ADDRESS I V I'l C( AL clty(StateIZIP <br /> PHONE(1): Cll,l��3�te�I`101 .. PHONE(2); FACSIMILE: qk —j —1010) <br /> TENTATIVE`APPOINTMENT DATE: Mrtrt � <br /> Time; f e__ <br /> (Please allow 10 business days from date of appll tion submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE VEST-$105 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN a BUSINESS DAYS <br /> SIGNATURE OF APPLICANTS DATE 100 I20 J( 9 <br /> Electronic Information: ❑ List❑ Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# street Name CI (-] Unit 1 <br /> ni<z <br /> 2. <br /> 3' I - ❑ Unha' <br /> 4. <br /> 5 ❑ Unit4 A ' <br /> 6. <br /> 7. 14J j ❑ Units <br /> 8. / <br /> 9. ❑ Unite <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 'ERGROONDTANK(UST)CLEANUPSITE(LOP) O HOUSING ABATEMENT C3 SOLID WASTE FACILITYNEHICLE <br /> SR CLEANUP SITE(NON-LOP) nFOOD FACILITY E3WASTE TIRE <br /> NDERGROUND TANK(MONITOWNGIREMOVAL) ❑DOG KENNEL MDAIRY <br /> 'AZARDOUS WASTE GENERATOR M CHICKEN RANCH In W EWATER TREATMENT PLANT <br /> •TIERED PERMITTED FACILITY 13 MOTEUHOTEL MPER TRUCKIYARD/CHEM TOILETS <br /> d TATTOOIBODY PIERCING 11 POOL/SPA LANG USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPECIFY) <br /> — <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW - MONDAY-FRIDAY 8:00 AM- EXCLUDING.ULLoAY�. <br /> 1. List up to ten addresses In the space above, Select the typo(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)4.64-01a8 or mall to the address Indicate bove 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 behold for a maximum of five business days for review, Appointments <br /> should be scheduled accordingly. <br /> a. A fife that is actively being worked an 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 reorganised by EHD staff at the expanse of the applicant. <br /> Future file reviews by the some applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4a-09 0104109 PUBLIC RECORDS RELEASE APP FORM <br />