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1234 KLEINFELDER 18:11:22 12-03-2010 1 <br /> �n•c ncv,uvcu CCM t <br /> �1 � tgc�fy a.r. SAN JOAQUIN COUNTY J EHD LOG NUMBER <br /> <Pr(� Y S�� ENVIRONMENTAL HEALTH DEPARTMENT G <br /> i 600 East Main St, Stockton, CA 95202-3029 J <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd OL� ((�� Lt <br /> (' PUBLIC RECORDS RELEASE APPLICATION aE CI I-�" Gt Ctdt Se�S <br /> RGPLICANT:� y BUSINESS/AGENCY: <br /> RESS: 1��q G11\S}c«� CITY/STATE/ZIP: <br /> C <br /> �� PHONE(1 SN - PHONE(2): FACSIMILE: �j75 <br /> FONMI04 Vt $ITATIVE•APPOINTMENTDATE, Time: <br /> t•��M(()$E (Please allow 10 business days from dat f application bmittal-`Tentative only-must be confirmed) <br /> P CHECK BOX 70 EXPEDITE REQUEST-$122 FE SH OR CH K ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE A13iL:m <br /> Electronic Information: ❑ List❑ Map- Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name City Unit 1 <br /> 1. t � 5 <br /> 2. v Unit2 <br /> 3. <br /> 5. 0 C _ -- nit3 <br /> 6. <br /> 5 <br /> nit 4 <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to CVOC1Br�C" <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> L"JUyp6RGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIUTYIVEHKAE <br /> OT LEANUP SITE(NOWLOP) ❑F00o FACILITY ❑WASTE TIRE <br /> ��r�'QN��DE'R�GROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL <br /> I�nntnRDOUS WASTE GENERATOR DAIRY <br /> ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL <br /> ❑TATTOO/BOGY PIERCING ❑PDOLISPA ❑PUMPER E APPLICATION <br /> SITES TOILETS <br /> r�.�- LAND USE APPLICATION SI7E5 <br /> I� meuICAL WASTE FACILITY E]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 ug 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(2091 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 It 0) <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$122 deposit prior to review. <br /> ENO U6E ONLY <br /> END 4" 07(2911e <br />