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UA RENED SAN JOAQUIN COUNTY - EHD LOG NUMBER <br /> EOVOONMENTAL HEALTH DEPARTknEht <br /> Nk 't 5 2009 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIRUNIbitNTf#EXLfpt one: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.or <br /> PERMITISERV20 PUBLIC RECORDSRELEASEAPPLICATION 4m <br /> APPLICANT: `�� �J BUSINESSIAGENCY: <br /> ADDRESS: ^^ CITY/STATE/ZIP: <br /> PHONE (1) t/ PHONE (2): 15 FACSIMILE. <br /> TENTATIVE'APPOINTMENT DATE: ' , ©F 9 l 3 gTime: <br /> (Please allow 10 business days from date of application submittai-'Tentative onl -must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE QUE�S'(Tn$11�F(CASH}-� OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN SLX1l5[ I( Q DATE I d <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street C Street Name- City <br /> 1 El Unit 1 <br /> f <br /> 2. �.,. <br /> 3. nit 2 <br /> 4. <br /> 5. ❑Unit 3 <br /> 6. <br /> ❑Unit4 I� <br /> 7. <br /> 8. <br /> /1 _ � ❑Unit 5 <br /> 9. <br /> veri liGt t �lh�,, »o is <br /> 10. ilt5 }OI� f�V�i Qy It 1to� <br /> ❑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 <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY [_1 SOLID WASTE FAC0.ITYNEHICLE <br /> ❑UNDERGROUND TANK(MONnORINGIREMOVAL) ❑DOG KENNEL WASTE TIRE <br /> ❑HAZARDOUS WASTE GENERATOR ❑DAIRY <br /> ❑CHICKEN RANCH- ASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEUHOTEL PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA <br /> ❑ El LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8:00 AIM-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 lease contact Diane Martinez direct) @ (209)468-3425. Thank You*** <br /> FNA IpM ` <br />