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Nov 12 2009 5: 13PM .HP LASERJET FAX P, 1 <br /> DATE RECEIVED EHD LOG NUMBERSAN JOAQUIN COUNTY <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.or <br /> 11�,,', BUSINESSIAGENCY:PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: !� <br /> �L ( �_ . i <br /> � <br /> ADDRESS: " \N . � _ CITYISTATEIZIP: <br /> PHONE(1):�, � � Gj `� PHONE(2): FACSIMILE.'` (Q <br /> TENTATIVE'APPOINTMENT DATE- Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITER 5Fn H 0 NE ONLY) REQUEST PROCESSED IN 3 BUSINESS DAY <br /> SIGNATURE OF APPLICANT. DATE ., <br /> i <br /> Electronic Information: ❑List❑Map—Description: ` <br /> FILE ADDRESS EHD USE ONLY <br /> Street IR Street Nemo City ❑Unit i <br /> 12. ❑Unit2 <br /> 3. <br /> 4. ` <br /> nit3 <br /> 5. <br /> 6. nit 4 <br /> 7. <br /> 8. <br /> ❑unit 5 <br /> 9. . <br /> 10• ©Units <br /> Specific Dat■Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) , ❑HOUSING ABATEMENT ❑Sotto WASTE FACILFTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROIJNDTA14K"0NIT0RINGIRENIDVAL) ❑DOG KENNa ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATE R TREATMENT PLANT <br /> ❑TIERED PERMITTED FArAUTY ❑MOTE 11HOTf L ❑PUM PE R TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY Pi£RCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REviEw: MoNOAY-FRIDAY 8:00 AIN-5:00PM(EXCLUoING HOLIDAYS) <br /> 1. List"jo ten addresses in the space above. Select the types)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 mall 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 beheld for a maximum.of five business clays 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$115 deposit prior to review. <br /> 5, if you nee_d further assistance,please contact Diane Martinez,at(209)468-3426. <br /> - EHD USE ONLY <br /> EHD 48.06 - 8127M <br />