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F .r.. t)KIE n 408 260 8627 �, Mar. 28 2011 05:40AM P1 <br /> FIEDATE RECEIVED �� EHD LOG NUMBER <br /> l SAN JOAQUIN COUNTY <br /> rd(2 8 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEIV 600 East Main St. Stockton, CA 95202-3029 <br /> PERMIT/SERVICE `Phone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:' ' i BUSINESSIAGENCY:Jgcj <br /> ADDRESS: e CITY/STATE/ZIP: })1IL��W ql jl lJ <br /> PHONE(1): PHONE(2)' FACSIMILEAd)200-&2'eL <br /> TENTATIVE'APPOINTMENT DATE: WidaVAlto Time 1150 Oy- Cjoo <br /> J (Please allow 10 business days from date of application submittal-'Tentative only•must be confirmed) <br /> �Y CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> a Lt <br /> SIGNATURE OF APPLICANT I--I)L^{ 1 (`� 1 DATE I <br /> Electronic Information: &rList❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street# Sheet Name City U ' 1 <br /> __ + �1 <br /> 2. 'bfr ,. ❑Unit2 <br /> 3. I _ ,C� I 0 <br /> 4. Unit S <br /> 6. Lj Unit4 <br /> 7. <br /> B Unit 5 <br /> 9. <br /> i0. Units <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH D P R7 T F <br /> DFRGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ) LID WASTE FACILITY/VEHICLE 1l <br /> �!OTHER CLEANUP SITE(NON-LOP) r❑r-t FOOD FACILITY El WASTE TIRE <br /> Et 1 <br /> dNDERGROUHD TANK(MONITORINGIREMOVAL) LJ DOG KENNEL ❑DAIRY 3� <br /> Lv H DOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATmrNT PLANT <br /> IERED PERmnTED FACILn ❑MOTELIHOTEL ❑PUMPER TRUCKNARD/CHEMICAL TOILETS <br /> ©TATTOOIBODy PIERCING ❑POOL/SPA ❑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 AM5:00pm(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of fifes 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 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(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 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$122 deposit prior to review- <br /> EHD USE ONLY <br /> -a s <br /> r d' <br /> 0 C <br /> " �$ CO 333 5 Envi gt0A /YJ1 S(OIW i5 'tn USTfi 16--fflf IIOHIV9,r1 <br />