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02/11/2510 - 17:14 3125430340 PAGE 01101 <br /> '. i <br /> RtURV <br /> IED <br /> p E X11 010 SAN JOAQUIN COUNTY <br /> EHl7Lt3GNt1MBER <br /> i 111 i( "tic T EALT f ENVIRONMENTAL HrmALTH DEPARTMENT <br /> 600 East Main St, Stockton,GA 95202-3029 <br /> PERMNY/ RVIC►E�7elepFlane:{209Y 468-3420 Fax:{209)464-0138 web:www.sjgov.olehd I <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:: Er,-4: L- 13U5INES IAGENCY., 6'A'.ej 7� <br /> ADDRESS. -7ZO- A 4t, ?A /Ie it '417600 CITYISTATErZIP�G4t.'�a�r� <br /> PHON`(1): PIio_ NE(2) FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Pleswe allow 40 business days frays date of,IPPil-tion submittal--Teritat ve only,mast be tett-rmed) <br /> CHECK BOX TO EXPEDITE REQUEST 41115 FEE(GASH OR CHECK ONLY)•REQUEST"PROCESSED;N 3"8USINESS DAYS <br /> SIGNATURE OF APPLICANT -- _ DATE 7 1 11 f fes <br /> Electronic Information: ❑List 0 Map Description: <br /> FILE ADDRESS EHD USE ONLY <br /> z �... <br /> Street Street Name City �[]Unit1 <br /> F22� <br /> unit <br /> 3. <br /> 4. IN <br /> Y" <br /> r - <br /> 2. <br /> $ �-0 Unit 5- <br /> ;;nk s <br /> jr <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNE)ERGROWDTANK(07)CLEANUPSrrE(Lt1P) ❑HOUSING A6ATMENr ❑SOLID WASTE FACILI>YNEIMCLE <br /> 0 OTHER CLEANO SITE(Neu-LOP) ❑FOOD FACILITY WASTE Tw- <br /> 1UNDERGROIiNo TANK(MoNrioRN~(REMOVAL) ❑DOG KENNEL DAIRY <br /> HAZARD0USWAwGENIEPATOR ❑CHICKEN RANCH WASTEWATER TREATMENT F'LW <br /> TIERED PEWMED FACILITY ❑MoTEL/HOTEL ❑PUMPER TRI:JCKIYARD1F,hiFd CAL TOILETS <br /> TATTTOO/15ODY PIERCING 0 P'OOLISPA LAN©USE APPLIGAT*NSITU <br /> �] MEmCAL WASTE FAaLtTy ©OTHER(PLEASE SPECIFY) <br /> WELL.AND SEPTIC PERMIT RECORDS ARE AVATLAULE Fort ReyiEw: MoNdAY•FRiDAY 8.tlfl Am-5. 0Fm(EXCLUDING 111OUDAYS) <br /> 1, List a to ten addresses in'the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box("). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the address indiaat+ad_Bove. Address <br /> ranges will not be accepted-foraddltlonai assistance with file addresses,contact the EMO, Applications received after <br /> 3:06 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist 1 An appointment for review will be confirmed approximately testi(10) i <br /> days after receipt of application. The files will be held-for amauimum of five business days for review- Appointi't►erits <br /> should W scheduled acaordhlgly: <br /> 4 <br /> 3. A file that is activaly being worked on byEHO staff`ma}r n+�t be immed€ately available for review. Anew application may he <br /> submitted when the file is available: <br /> 4, Any file not returned in ft same condition.as released will be reorganized by SHD staff at tha expense of the applicant. <br /> Future file reviews by the same;applicant tnay require a$116 deposit prior to review. <br /> S: If you rwed further assistance,please contact Diane Martinez,at(209)4W3426. <br /> 9140 US9 ONLY <br /> EH5,o11-06 _. T <br /> t <br /> ). <br />