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FROM JODI VANNEMAN FAX NO. : 4154793988 Oct. 08 2010 10:47RM P2 <br /> EHD LOG NUMBER <br /> SAN JOAcaulN COUNTY <br /> 1J U ENVIRONMENTAL HEALTH DEPARTMENT <br /> UC;C Q $ Z010 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 404-0138 Web: www-sjgov.or eh f17 <br /> ENVIRUNIVILN I HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> P (j /i <br /> APPLICANT: � BUSINESS/AGENCY: � V� COh U h <br /> ADDRESS: rGt1IiG �_ CITYISTATEIZIP: A <br /> PHONE(1): 60 PHONE(2): -59� FACSIMILE: <br /> TENTATIVE*APPOINTMENT(TATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative Only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST•$122 FEE(CASH OR CHECK 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 NameCity Unit 1 <br /> �—.- <br /> r3, <br /> nit 2 <br /> 4. nit 3 <br /> 5_ <br /> - ., <br /> 7. 4 100� <br /> $• �,i Unit 5 <br /> 9. <br /> in• E]Unit B <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILETS <br /> ..J;'1NDFRGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICI.F <br /> 'OTHER CLEANUP SITE(Now LOP) ❑FOOD FACILITY WASTE TIRE <br /> �}/ UNDERGROUND TANK(MONITORtNGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> IAZARDOUS WASTE GENERATOR [:)CHICKEN RANCHASTEWATER TREATMENT PLANT <br /> �I IERED PERMITTED FACILITY ❑MOTEL IHOTEL �UMPER TRUCKIYARDICHEMICAL TOII_FTS <br /> ❑TATTOOISODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL,WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REvIEw: MONDAY-FRIDAY 8:00 AM-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. .List un eD addFesses 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 END. 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 rectipt 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 /> __,.........,.,.........,_ EHD U56 ONLY <br /> EHD 49.66 ^-�•-^ <br /> 0729110 <br />