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Nov 12 2009 5: 13PM HP LASERJET FAX P, 1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN .1OAQUIN 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 /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: � � BUSINESSIAGENCY:I)Y' , lG <br /> ADDRESS: cj^YO �� CITY/STATEIZIP:_ <br /> PHONE(1):C11 1` } G� � PHONE(2): FACSIMILE�ILL�'� �(P <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 EXPEDITE R- S - 115 F SHO HE K ONLY)-REQUEST PROCESSED IN 3 BU [NESS DAY <br /> SIGNATURE OF APPLICANT DATE I _ <br /> Electronic Information: ❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street s Street Name city ❑Unit 1 <br /> F2,. <br /> . _ ❑Unitz <br /> 3. <br /> 4. -- - — - — - 4nit6. <br /> 7. <br /> S. ❑Units <br /> 9. <br /> 10. ❑unit <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TASK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILFTYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FCOO FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGMEmoml-) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MDTELIHDTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TAT700IBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)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 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$115 deposit prior to review. <br /> 5. If you need further assistance, please contact Diane Martinez,at(209)468-3426. <br /> EHD USE OYLY <br /> EHD 18.06 - - - - 6/27/09 <br />