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":R II FIRE <br /> ` FJ�R, KIF 408 260 8627 • Mar. 28 2811 05:40AM P1 <br /> DATE RECEIVE^D i' EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> tl:)� Z S 2011 ENVIRONMENTAL HEALTH DEPARTMENT { <br /> ENVIRONMENTAL HEj 600 East Main St. Stockton, CA 95202-3029 <br /> PERMIT/SERVICES-phone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY:��j <br /> ADDRESS: CITY/STATE/ZIP:�Aant AI q�lw <br /> PHONE (1►: � WSW <br /> PHONE(2) FACSIMILE: )22 Q r1LSJ2 <br /> TENTATIVE'APPOINTM NT DATE: F-Y1 Time: 11 6rCidO <br /> (Please allow 10 business days from data of ap icahon submittal-"Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ���i 1, �(C�1�J DATE <br /> Electronic Information: List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street Strut Name city Uniti <br /> 2. -._ Unit 2 <br /> 3. r _ <br /> 4- _ Und3 <br /> 6. Unit 4 <br /> 7. <br /> B. U]Unit 5 <br /> 9- <br /> 10. Unit s <br /> Specific Date Range of Information Requested! From toF <br /> ���/// ENVIRONMENTAL HEALTH D PRT T F ,,��`` <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSINGABATEMENT LyyOLID WASTE FACILIfYIVEHICLE <br /> §�NNDFR <br /> OTHER CLFANUP SITE(NON-LOP) Er-lI FOOD FACILrrY ❑WASTE TIRE <br /> GROUND TANK(MONITORING/REMOvAL) LJ DOG KENNEL ❑DAIRY <br /> UOUS WASTE GENERATOR Er ]I CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> RFD PERMUTED FACILITY L!MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> [�TATTOOIBODY PIERCING ❑POOLI$PA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILADLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•S:00PM(EXCLUDING HOLIDAYS) <br /> 1. List u ten address 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 nerd 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 /> 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 /> EHD USE ONLY <br />