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Ror 27 2010 2: 22PM 51 "170 P. 1 <br /> DATE RECEIVED _iD LOG NUMBER <br /> SAN JOAQUIN COUNTYI J� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> A <br /> PUBLIC RECORDS RELEASE APPLICATION n <br /> APPLICANT: !4)1 Gt C T� (n mow`U BUSINESS/AGENCY: �. IZA <br /> ADDRESS: Z5�00 ( fylllsyJ- `_f A CITY/STATFJZIP: <br /> PHONE (1): PHONE ( :c FACSIMILE: io uF 2 V <br /> TENTAT/VE'APPOINTMENT DATE: �t) In Time: <br /> (Please allow 10 business days from date o.fI4I .on submittal-*Tentative only-must be confirmed},i <br /> ❑ CHECK BOX TO EXPEDITE REQ ST 115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 B Slrt.=SS AYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ON <br /> Street# Strout Name City Unit 1 <br /> - :Q"UM <br /> 2. Unit 2 <br /> 3. <br /> 7 <br /> 4. - <br /> 5. ---- - ;iVI-RtJ i{'EN _ nit 3 <br /> --- — - PERMIT/%QjERV1i;ES <br /> s. <br /> n <br /> 7. <br /> 8. <br /> —_ ❑ Unit 5 <br /> 8. <br /> 10. <br /> Unit 6 <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 FACILTYNEHICLE YV <br /> ER CLEANUP SITE(NON-LOP) ❑FOOD FACILITYWASTE TIRE <br /> NOERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH <br /> ❑WASTEWATER TRE!{-MENT PLANT <br /> IERED PERMITTED FACILITY ❑MOT[LIHOTEL ❑PUMPER TRUCK/YAhICHEMICAL TOILETS <br /> 9TATToo/BODY PIERCING ❑POOLISPA >6LAND USE APPLICALON SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00 PM(ExcLM ING HOLIDAYS) <br /> 1. List uR 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)4640138 or mail to the address indicated ata-ave Address <br /> ranges will not be accepted-for additional assistance with file addresses, contact the EHD. Applications a lceived 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 appro;_.imately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Apjointments <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 E ie applicant. <br /> Future file reviews by the same applicant may require a $115 deposit prior to review. <br /> 5. If you need further assistance, please contact Diane Martinez,at(209)468-3425. <br /> END USE ONLY <br /> I <br /> EHD 48.06 ° <br /> 9!27!09 <br />