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Jun 01 10 01:14p FP17Y Envir 61, Inc. 1644 p.2 <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> tl tl <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> jUN 0 1 1010 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIRONfi' fllj HEAtphone: (209) 468-3420 Fax: (209) 464-0138 Web: www_sjgov.org/eh <br /> P g PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �� �� ►v>+ BUSINESS/AGENCY: v�roww( <br /> ADDRESS: 1 ��P 5-A - CITY/STATEIZIP: t1sZ �a02 <br /> PHONE(1): - (lG PHONE(2): �f /��( • (pSlaT FACSIMILE: <br /> TENTATI *APPOINTMENT DATE: A54P Time: <br /> (Please allow 10 business days from date of plication submittal-'Tentative only-must be confirmed) <br /> HECK BOX TO EXPEDITE RECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1. LA 1C14 C-t '� a <br /> 2 ❑Unit-2 <br /> s. 3 <br /> 4. <br /> .1, <br /> 5. 4 <br /> 7. _. <br /> g ❑Unit 5 <br /> 9. <br /> 10. nit 6 <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> +UNDERGROUNDTANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT OLIDWASTE FACILITYNEHICLE <br /> OTHER CLEAN UP SITE(No N-LOP) ❑FOOD FACILITY WASTETIRE <br /> SQ UNDERGROUND TANK(MONITORI NGIREM OVAL) ❑DOG KENNEL ❑DAIRY <br /> FHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMFITED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYAROICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ]LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY JAPTHER(PLEASE SPECIFY) C n4ftw- tim <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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 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 proces9�edthe xtaus4ness�daay. <br /> 2. The EHD will notify the Apphcr fht If hj/_EHD fnes�a ist. An appointment for review will be confirmed approximately ten(10) <br /> ,Tliefle5,vi[I'b'e�t eld for a maximum of five business days for review. Appointments <br /> days after receipt of appllcatioR <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)468-3425. <br /> EHD USE ONLY <br /> &27109 <br /> EHD 4846 <br />