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5-22-09; 8:30gN.;✓,lel nfei 1,de.sto <br /> 2095753444 <br /> DATE RECFE€(P0 <br /> ( I I,L/ L,-� SAN JOAQUIN COUNTY EHD LOG UMBER <br /> `� UENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 L 9 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/e d5 02 <br /> Ei%IVF,s )NIMI_P1VT HEALTH <br /> PEHh!1T/SE8,V1CFtJBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: i'{Jm �5q <br /> BUSINESS/AGENCY: <br /> ADDRESS: ....CC77 a� b� Q � 9535 <br /> ki 14 <br /> PHONE(1):_ , ll7-'V3 TENTATI APPOINTMENI PHONE(2): <br /> FACSIMILE: 75-3 <br /> TE: <br /> (Please allow ten business da from date of application submittal-•Tentative Only <br /> lmmust be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST.$ s, 0 EE(C H OR CHECK ONLY)•REQUEST PROCESSED IN THREE BUSINESS D YS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Electronic Information: ❑ List�Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name <br /> 1 � f city \ ❑unn t <br /> z. <br /> 3, nit2 <br /> 4. <br /> 6. X11 <br /> 7. <br /> 8. <br /> 9. <br /> ❑ nit 5 <br /> 1.0. <br /> ❑ nits <br /> Specific Date Range of Information Requested:From <br /> to <br /> �/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑ <br /> OTHER CLEANUP SITE NON-LOP SOLID WASTE FACILITYNEHICLE <br /> ( ) ❑FOOD FACILITY ❑WASTE TIRE <br /> ,PI'ONDERGROUND TANWASTE <br /> GENERATOR <br /> 13 DOG KENNEL ❑DAIRY <br /> �,0'9A2ARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> .2 TIERED PERMITTED FACILITY ❑MOTELIHOTELPER TRVCIWARD/CHEM TOILETS <br /> C3TATTOOIBDOY PIERCING 13FOCIFOO <br /> ❑MEDICAL WASTE FACILITYAJ LAND USE APPLICATION SITES <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW. MONDAY-FRIDAY 8:00 AM-5:OOPM - <br /> E%CLUOING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to Will 464-0136 or mail to the above address, Address ranges ill <br /> not be accepted-for additional assistance with file addresses,Contact the EHD. Applications received after 3:00 <br /> be processed the next business day. pm 111 <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten <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 the EHD staff may not be immediately available for review. A new application <br /> may be 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHO a6-O6 10I39Mr <br /> ±'U"'I'�EAPIP <br />