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05/03/2010 14:57 4085597;91 AEI SAN JOSE PAGE 01/01 <br /> MD <br /> n, ��_, FE--iNE <br /> DATE RECEIVED. EHD LOG NUMBS <br /> 3 �/U I SAN JOAQUIN COUNTY <br /> R 11 4r I ENVIRONMENTAL HEALTH DEPARTMENT <br /> Ef�1���if�s0NN1,it_ i ; ,:�,� <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> �t ti4q'T`ul_ "i' Iephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ I of I BUSINESSIAGENCY: J_ ca/-&U <br /> ADDRESS: 6 SCS a CITYISTATE ZIP: <br /> PHONE(1): l PHONE(2): uU n FACSIMILE: T Q <br /> TENTATIVE'''AFFVINTMI:_NT DATE: Time: <br /> (Please allow 113 business days from date of application submittal-"Tenistive only-must be confirmed) <br /> [:]CHECK BOX TO EXPEDITE REQUEST- 1 FE (G H R CHE K ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT TW �Z� DATE LJ S <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1. Z5 T40 FL_v- . <br /> ❑Unit 2 <br /> a. <br /> Unit 3 <br /> 5. <br /> O. `6A Unit 4 I, <br /> 7, 7 <br /> $ I _ [I Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �ONDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRuryNARDICHEMICALTOILETS <br /> ❑ ATTOOIBODY PIERCING Q POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) OI�q <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:DO AM-S:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List un to 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(20914WO138 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 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 stat{may not be immediately available for review. A new application may be <br /> submitted when the file Is available. <br /> 4. Any file not retumed 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,pl®ase contact Diane Martinez,at(209)468-3425. <br /> EHD USE ONLY <br /> EHD 48.08 8127!09 <br />