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10/02/2008 1017 FAY � i�j00.1/001 <br /> DAT� i, !' i } EHD LOG NUMBER <br /> Q)� r SAN JOAQUIN CQUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> OCT 2 2008 600 East Main Street, Stockton, CA 95202-3029 Q <br /> . Telephone: (209)468-3420Fax: (209)464-0938 web: www.sjgov.orglehd <br /> V <br /> NVIRUl NEAT �EALRi <br /> PFRkril SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINEWAGENCY: <br /> ADDRESS; CItylStalolzip [ <br /> PHONE(1); 14? PHONE(2)- 5Q69FACSIMILE: <br /> TENTATIVE"APPOINTMENT DAT Time: <br /> (Please allow 10 business dsy fro date of appi tion aubmlttal-'TBntaUva only.-must b eenflrmod) <br /> El CHECK BOX TO EXPEDITE R CIU - 06 FEE CAS R ONLY)-REQUEST PROGESSED IN S BUSIN 9 DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> EleCtronic Information: Q List EyMap—Dest:rlpt on: _ <br /> FILE ADDRESS EHp USE ONLY . . <br /> Street# Street Name CI <br /> F12. <br /> a a -R0s o ftt0 <br /> 1Q 0 7� Unit 2 i`JI <br /> 3. <br /> 4 � Unit 9 <br /> 5. <br /> S;2,4 W,Unit4 <br /> e <br /> TVA-M ) ` f <br /> Unit.5 <br /> 9. Unit 6 <br /> 7o. O off. Y" 8 Oil 1 L <br /> Specific Date mange of lniarrnation Requested:From to _Wesen�- _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Nol R13 _-TANK(UST)CLEANUP 317E(LOP). a Hoti31N6 ABATEMENT ❑WASTE FACILITYIVEFucLE <br /> HER CLEANUP SIT'(NON-LDP) ¢FOOD FACILITY TE nM <br /> NDERGR1 1N.TANK(MONK-7,1REMOVAL) ❑'DOG KENNWL AFRY <br /> A7{►FiDOUS WASTE GENERATOR 0 CHICKEN RANCH STEWATER TF1EATMEN7 PLANT <br /> D TIERED PI:RhaYTEO FACILITY 0 MUYEt1HOTEL Iu1PER TRUCKIYARDICHEM TOILET <br /> ❑'rATToo/BovT PIERCING E3 POOL/SPA Nb USE APPUcATION SITES <br /> .ID MEWCAL WAST!•FACILITY OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MoNDAY-FpjDAY 9:00 Am-6:00PM -ExcLUDINa HouDAYs, <br /> 1. List up to ten addrossos in the space above. Select the type(s)of files from the list above by chocking the appropriate <br /> box(es)- At least one file typo MUST be selected_ Fax to(209)464943U gr mail to the adds" a indicated abQ Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD. Applications received aftar <br /> 3:00 pm will be processed the next business day, <br /> 2. The EHD will notify the epplfcant if-any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies will behold 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 filo rovlews by the same applicant may require a$105 deposit prior to review. . <br /> EHD USE ONLY <br /> EHD 46-06 6!04!09 PU9LIC RECORDS RELEASEAPPFORM <br />