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Apr 23 10 09: 47a Krazan & Associates 55934e 90 P. 1 <br /> IMD <br /> N tLYE�L=J <br /> SAN JOAQUiN COUNTY EHD LOG NUMBER <br /> Ap'? 3 2410 ENVIRONMENTAL HEALTH DEPARTMENT <br /> T� -��u 600 East Main Street, Stockton, CA 95202-3029 <br /> ERViRUIV elephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMITISEMAGES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: S?I4N f PrSSCCi1�( 5,, �N�.• <br /> ADDRESS: –21–S by- FIAie_5T4 A-V2_ � city/Statetzip - CA ? _36(-!A <br /> � <br /> PHONE(1): 4 S9.• 14 . a tll0 PHONE(2): FACSIMILE: — • :314 • X10 _ <br /> TENTATIVE'APPOINTMENT DATE; (-NSPt ' _ _ Time: <br /> (Please allow 10 business days from date of application submittal Tentative only-must be confirmed) <br /> © CHECK 13OX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS j <br /> SIGNATURE OF APPLICANT DATEi i <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City El unit 1 <br /> 2. t1 nit 2 <br /> 4. nI 3 <br /> 5. <br /> 6. Unit4 <br /> 7. <br /> ❑ Unit S <br /> 8. <br /> 9. lie <br /> Unit 6 <br /> 1 D. <br /> Specific Date Range of Information Requested: From Ptto <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ONDERGROUND TANK(UST)CLEANUP 5rrE(LOP) HOUSING ADATEMENT SOLID WASTE FACILITYIVEHICLE <br /> 13THER CLEANUP SITE(NoN-LOP) ❑ FOOD FACILITY AWAsT£ TIRE <br /> XUNDERGROUNDTA19K(MONITORING/REMOVAL) 0 DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 1(WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> CI TATTOOIBODY PIERCING 13 POOUSPA ❑ LAND USE APPLICATION SrrES <br /> O MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC;PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:O11 Am-5:00PNs - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the types) of Iles 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 next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist.'An appointment for review will ba confirriced 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> E"D 0.06 0IOV08 PUBLIC RECORDS RELEASE APP FORM <br />