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Cil/11/LUUZ:) LU:44 'Jib'7bb.J2`JU DEL 10 PAGE 01 <br /> -------------- <br /> F(EcENE -- ------- ----------- ----- -------- <br /> n1 <br /> DAT�y{3f(�Ego 2�11� EHD LOG NUMBER <br /> I tU Y SAN JOAQUIN COUNTY 0 <br /> NA1ENTAL"EAl--T" ENVIRONMENTAL HEALTH DEPARTMENT <br /> �tfVIRO 600 East Main St. Stockton, CA 95202-3029 <br /> PERMI-I-�SERVIC Telephone: (209)468-3420 Fax: (209)464-0138 Web, www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> MATT SMALLER ANTEA GROUP <br /> APPLICANT: BUSINESS/AGENCY:_ � <br /> ADDRESS: 9241 LA SERENA DRIVE CITY/STATE/ZIP:� FAIR OAKS�C jq <br /> PHONE(1): 916 966 3290 PHONE(2): FACSIMILE: 916 6'38 8385 <br /> TENTATWE®APPOINTMENT DATE, Time: <br /> (Ploase allow 10 buainass days from date of application submittal-•7anfativa only-must be confhmad) <br /> ❑CHECK BOX TO EXPEDITE REQUE=ST-$115 F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List[] Map- escription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street* Street Name City Unit 1 <br /> 1• 1206 E MARCH LANE STOCKTON <br /> ZOI °1s2..1_J . - ❑Unit 2 <br /> 3. -- <br /> 4. <br /> Unit 8 <br /> 6. <br /> � Unit 4 <br /> 7'_ <br /> l3• Unit a <br /> r <br /> 10. <br /> ❑unit ej <br /> Sp*clffc Date Rang*of Information Requested From ALL to PRESENT <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ®TIERED PERMITTED FACILITY ❑MOTEIIHOTEL ❑PUMPER TRUCKNARUCHEMCAL TOILETS <br /> ❑TATTOOBODY 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 9:00 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(208]4@4-0138 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 /> 8:00 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 recelpt 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(208)468-3425. <br /> EHD USE ONLY <br /> EHD 48-96 <br />