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07/12/2010 11:05 8052 009 <br />SIERRA DELTA CCOT <br />PAGE 01/01 <br />EHD LOG NUMBER <br />DATE RECEIVED <br />SAN OAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 (East Main St. Stockton, CA 95202-3029 <br />"telephone: (209) 4683420 Fax: (209) 464-0138 Web: www.sjgov.or e 4 <br />PUBLIC RECORDS RELEASE. APPLICATION <br />APPLICANT: (M S BUSINESSIAGENCY: J�4S�S <br />ADDRESS: 1 J kd c� I CITY/STATEIZIP. <br />PHONE(l): LIo� PHONE (2):_ FACSIMILE: <br />TENTATIVE" APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - "Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - 5 F (CASH OR HECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT fA1nS DATE � " 1 1;�) <br />Electronic Information: ❑ List ❑ Map -- Description <br />Specific Date Range of information Requested: Fromw <br />ENVIRONMENTAL. HEALTH DEPARTMENT FILES <br />(UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br />ROTHER CLEANUP SITE (NON -LOP) F1 FOOD FACILITY [j WASTE TIRE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) F-1DOGKENNEL ❑ DAIRY <br />C3 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATFR TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY 0 MOTELIHOTLL ❑ PUMPER TRUCKNARDICHEMCAL TOILETS <br />❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />t� 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 up to ten addmjjEes 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 (2091464-0138 or mail to ts>a 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 flies 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 avallable. <br />4_ Any file not returned in the same condition as released will W reorganized by EHD staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $115 deposit prior to review. <br />5, If you need further assistance, please contact Diane Martinez, at (209) 468-3425. <br />