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SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> EN.iRONMENTAL HEALTH DEPARTMLCNT <br /> IN, ,.0 5 2009 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIRONMENT�� ��t <br /> T hone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.or <br /> 4 Aq <br /> PERMITiSERVECES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: //d �� BUSINESSIAGENCY: L_ <br /> ADDRESS: l J CITYISTATE/ZIP:, <br /> PHONE (1)• Q PHONE(2): FACSIMILE. <br /> TENTATIVE*APPOINTMENT DATE: 'tC _ © F <br /> (Please allow 10 business days from date of application submittal-*Tentative onl -must be confirmed) <br /> [] CHECK BOX TO EXPEDITE�QUEST-$�lS1500.F (CA}SyH OR CH/�ECK ONLY)-REQUEST PROCESSEDIN USINESS DAYS <br /> SIGNATURE OF APPLICANL�)l�Q L lI� DATE � 1 L ac) <br /> Electronic Information: ❑ List❑ Map— Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> E]Unit 1 <br /> 1. <br /> 2. <br /> $. Ai ,, <br /> 4. -- I ' <br /> __ _ ❑Unit 3 <br /> 6. <br /> ❑Unit 4 �� 1 <br /> 7. <br /> B _ - <br /> - -- - ❑Unit 5 <br /> s. veri --ull Carl tO ch mo is r es <br /> 10. P;les to lx rev�ev)M r,-, A- N erY,h <br /> I l I In l ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH <br /> F]TIERED PERMITTED FACILITY ASTEWATER TREATMENT PLANT <br /> . El PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA <br /> ❑ MEDICAL WASTE FACILITY ❑LAND USE APPLICATION SITES <br /> ❑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 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(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 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 $115.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance Please contact Diane Martinez direct) @ (209)468-3425. Thank You*** <br /> AHD Ax.na <br />