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To.SJC Page 1 of 1 2009-10-13 17:09:54(GMT) 15103720452 From:Tim Loeb <br /> EI{U LOG NUMBL=R <br /> SAN JOAQUIN COUNTY <br /> ] ENVIRONMENTAL HEALTH DEPARTMENT <br /> I �It`i � g 600 East Main St. Stockton, CA 95202-3029 <br /> hone: (209)468-3420 Fax: (209)4640138 Web:www.sjgov.org/ehd <br /> Ct PUBLIC RECORDS RELEASE APPLICATION <br /> K APPLICANT: Zoe 6. BUSINESSIAGENCY: <br /> ADDRESS. / '7t9 S P _ CITY/STATEOP: ' ti LD�P+tiZC <br /> PHONE(1): S io Q7 1 Y-5-4(0 PHONE(2): _ FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE:_ _ _ Time: _ <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> f <br /> CHECK BOX TO EXPEDITE REQ ST-$115 FEE(CASH OR(7 CK ONLY)-REQUEST PROC ESSFD IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT j „ ,e <br /> -- - �,�_ _----- -- DATE �/1.z -- <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 2. <br /> El❑Unit 2 <br /> 3. \ <br /> 4. Unit 3 <br /> .y <br /> 6. I nit4 <br /> 7. <br /> 8. ❑Unit 5 <br /> 9 <br /> 10. ❑Unit s <br /> I <br /> Specific Date Range of information Requested: From _ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ~,UNDERGROUND TANK(UST)CLEANUP SITE(LOP) LI HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHK LE <br /> _[�+OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTL TIRE <br /> _j UNDERGROUND TANK(MONITORINGIRLMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMIITED FACILITY ❑MOTEL MOTEL ❑1 PUMPER TRUCKIYARDICHEMICAL TOILFTS <br /> TATTOOIBODY PIERCING ❑POOLISPA LJ LAND USE APPLICATION SrrES <br /> MLOK:ALWAS IL FACILIIY ❑0fH1 R(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List un 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(249)464-0136 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 END 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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EHC USE OHLY <br /> c <br /> EHD 4" 8�27J09 <br /> _.�,..�,.,..�a,_,-._...... __.. _....,.r.�......—m--- _._......_..__..�,._— - ...... <br />