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FPD11 C i ca 1 /H i Rm'mmw .cal Con PHONE NO. : 510 6540635 JUL, 0-7 2011 080:45AN P1 <br />� <br />FE <br />re SAN JOAQUIN COUNTY EHD LOG NUMBER <br />JUL 1�4 Oil ENVIRONMENTAL HEALTH DEPARTMENT <br />ENVIRONMENTAL HW 600 East Main St. Stockton, CA 95202-3029 <br />PERMITI(SERVICE 10phone- (209) 468-3420 Fax: (209) 464-0138 Web; www.sjgov.org/ehd <br />E �e. <br />PUBLIC RECORDS RELEASE APPLICATION <br />BUSINESS/AGENCY. Xig, <br />ADDRESS; <br />CITYISTATE21p:— <br />PHONE (1): <br />PHONE (2)- FACSIMILE:, ;76 <br />c;<-j-4�- �6 <br />TENTATIVE* APPOINTMENT DATE--_-:' ?10/ -" Time. f :0 C) "5� <br />(Please allow 10 btlSirmm days from date of _pPlIcationubm- <br />I *TWt—adveonlY - mLmt he Coarmod) <br />— <br />CHECK BOX TO EXPEDITE REQ�YPT - $122Z CH "LY) -,REQUEST PROCESSED IN 3 SUS DAYS <br />SIGNATURE OF APPLICANT - =1-0111r�- � <br />DATE <br />IR mil 57 9 1 a . 0 ..' <br />1-416Q EHD USE ONLY <br />Street 0 Street Name city 42 jUn I <br />coy A) o <br />2. <br />unit 2 <br />4. <br />n I t3 I/ <br />Ll <br />Unit 4 <br />7. <br />iJllli 4J <br />M <br />Q unit <br />Specific Date Range of Information Requested. From to <br />EN%ARONMENTAL HEALTHDEPARtMEFT/- <br />FILES —0c f <br />o <br />91NDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT El SOLID WASTE FAC 4UTYIVEHICLE f <br />n -OTHER CLEANUP SITE (NOW -LOP) n FOOD FACILITY EIWASTE TIRE1 <br />UNDERGROUND TANK (MONITIOPiNG(REmOVAL)k [D DOC KENNEL [] DAIRY LW 1 4 5, <br />aNAZARDOUS WASTE GENERATOt� 0 CHICKEN RANCHEl WASTEWATER TREATMENT PLANT <br />[] TIERED PERmrrTED FACILITY [I MOTtL/HOTEL PUMPER TRUCKNAROICHEMICAL TOILETS <br />El TATTooffiooy PIERCING POOLISPA LAND USE APPLICATION SITES <br />MEDICAL WASTE FACILITY OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDs ARE AvAILABLE FOR REviEw: MONDAY-FpjiDAY 8!00 Am-6-.0'OPM JEXCLUDING HOLIDAY$) <br />1. Upj Mp to ton 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 J2091 138 or mail Ag ftadd <br />L raw indicated ghp_ve. 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 new application may be <br />submitted when the file is available. <br />4. Any file not returned in the some 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 />