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07/22/2009 WED 15: 00 FAX 20° 82999 SJC Public Works m001/001 <br /> i <br /> cjLl SAN .10AQUIN COUNTY E LC <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> n Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> 14 00L�'� HE,L�-tj f t <br /> PER.MITi= RVI S PUBLIC RECORDS RELEASE APPLICATION t p C ` <br /> APPLICANT: Ck �� /� n __BUSINESS/AGENCY: S-\ P /\(/ <br /> ADDRESS: ���� G_ , Na x el {��. ve citylstate/Zip S --to-, CIq � <br /> PHONE(1): 1/4 f—�09 S, PHONE(2): FACSIMILE: 12049 <br /> I TENTATIVE"APPOINTMENT DATE: Time: <br /> ,(Pleaso allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE RE U ST- 1E CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT A DATE 7 Ra <br /> Electronic Information: ❑ List❑Map—Description: <br /> _ FILE ADDRESS __ _ EHD USE ONLY <br /> Street# Street Name J <br /> r2. cityUnit t <br /> u Z O — ❑ockaid 1( Unit 2 <br /> / 1" <br /> 3. 3 7t1 �✓G�.L���VU., ---- tlln � 9.Z-Zoo - <br /> 4. ��ZiZ. POW R04 <br /> LO '1 Unit3 <br /> 6' 1 PO Gt i�d O r t <br /> 6 Unit 4 <br /> 7. <br /> ---- <br /> - Unit 5 <br /> 8. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From to <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 /> .iJNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR. ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL .5 -PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑TATTOOIBOOy PIERCING ❑POOLISPA .LAND USE APPLICATION SITES <br /> 17 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 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 /> 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> END 48-D6 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />