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1234 KLEINFELDER c>n�,1:37 - 2010 1 11 <br /> SAN JOAQUlN COUNTY �, • <br /> 1-� VIRONMENTAL HEALTH DEPARTMENT <br /> SEP 1 7 1018 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIRONMENT HEAM <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web. www,sjgov.org/ehd <br /> PUBLIC RECORDS RELE <br /> PERM ASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: a� 111 <br /> PHONE 1 �� CITYISTATE/ZIP: (1 <br /> � ) 5� � �3� PN NE(2): FACSIMILE: �a 57 31,K 11 <br /> TENTATIVE*APPOINTMENT DATE. Time; I <br /> (Please allow 10 business days fro ate of apptica on submittal•'Tenfauve only-must be confirmedi <br /> . j <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$12 E (CASH O CHECK ONLY)-REQUEST PROCESSE N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT C��j <br /> ..I"t-G s"DAA <br /> Electronic information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street ik Street Name City <br /> 1. I ❑Unit 1 <br /> 2. I �00 <br /> 3. <br /> � Unit 2 <br /> �( dam coo. <br /> t 4. <br /> Unit 3 <br /> 6. <br /> 1 unit 4 <br /> 7. <br /> 8. <br /> 9 ❑Unit 5 <br /> 10, <br /> k1un it 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> � ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ElSOLID WASTE FACIUTYNEHICLE <br /> L_kll VT�ER CLEANUP SITE(NON-LOP) ❑FOOD FACILfTY ❑WASTE TIRE <br /> [�� �GROUNDTANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> b HAZARDOUS WASTE GENERATOR PtTrICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL <br /> ❑ PUMPER TRUCKIYARDICHEMICAL TOI <br /> TATTOOIBODY PIERCING ❑ LETS <br /> ❑POOLISPA USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 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 /> 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 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 EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file Is available. <br /> f 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$122 deposit prior to review. <br /> &SD USE ONLY <br /> I <br /> EHD 46-06 07129110 1: <br />