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OCT/2,�12010/MON 05:05 PM BANK THE WEST FAX No, 20947834 P- 001/001 <br /> SAN JOAQUIN COUNTY EHD LOU NUMBEFJ� <br /> U(:12 6 2010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIRONMENT HEANIephone: (209)468-3420 Fax! (209)464-0138 Web:WwW.sjgoV.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION q JJJ <br /> APPLICANT: � BUSINESS/AGENCY:, Vt" — �� Q <br /> ADDRESS: G � k). CITY/STATE/ZIP:� ,Vi 19�JC'j� <br /> PHONE 14--7 PHONE(2): U FACSIMILE: <br /> TE'NTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'1'enfaSVe only-must be confirmed) <br /> Q CHECK BOX TO EXPEDITE REQUE& -$1�FEE' HE l NLY)-REQUEST PROCESSED IN 3 BUS NESS AYS <br /> SIGNATURE OF APPLICANT�� DATE a <br /> Electronic Information: ❑ List 0 Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name City <br /> Unit 1 <br /> 2 I� ,a.7 <br /> 3 Unit 2 <br /> 4. <br /> 5. Unit 3 -� <br /> 6. <br /> 7. Unit 4 <br /> 8. <br /> 9 _ _ ❑unit 5 <br /> 1 q. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested, From Q to ) <br /> EN01 <br /> VIRONMENTAL HEALN DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ElDOG KENNEL [❑DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERWITED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> Q TATTOOIBODY PIERCING (❑P06LISPA <br /> ElMEDICAL WASTE FACILITY ❑LAND USEAPPLICATION SITES <br /> ❑OTHER(PLEASE$PECIIY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List un 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. Fazio(209)484.0138 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 now 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 EMD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may requlrem$122 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 49.06 <br /> 0129/19 <br />