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DARMtSAN JOAQUIN COUNTY EHD Loc NUMBER <br /> NED <br /> EN V-IRONMENTAL HEALTH DEPARTMcNT <br /> iNi: : i 5 2009 600 East Main St. Stockton, CA 95202-2708 <br /> hone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.or <br /> ENVIMNNIE i l <br /> PERM 3T!$ffl[C! PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> OS BUSINESSIAGENCY: SGL . <br /> ADDRESS: CITYISTATEIZIP: <br /> PHONE (1)• <br /> V01P HONE (2): FACSIMILE. <br /> TENTATIVE*APPOINTMENT DATE:W�� (n F Time: � <br /> r <br /> (Please allow 10 business days from date of application submittal-*Tentative onl -must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE QUEST-$115 00 F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN BUSINESS DAYS <br /> SIGNATURE OF APPLICAN I - DATE <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> ❑Unit 1 <br /> 1. <br /> 2. , '7, . <br /> I <br /> 4. <br /> -� ❑Unit 3 <br /> 5. <br /> 6. ❑Unit 4 <br /> 7. <br /> 8. <br /> n � � ❑ Ujt6 <br /> 9. v��i lii-u <br /> 10. r; [e5 f0 i- I eued m A- N es+�h <br /> t t E] Lin, <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) ❑Foot)FACILITY ❑SOLID WASTE FACILiTY1VEHICLE <br /> ❑ <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) [:1 DOG KENNEL WASTE TIRE HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH DAIRY <br /> ASTEWATER TREATMENT PLANT <br /> F]TIERED PERMITTED FACILITY ❑MOTEUHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑ ATTOOIBODY PIERCING ❑POOLISPA. <br /> FlMEDICAL WASTE FACILITY ❑LAND USE APPLICATION SITES <br /> El (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 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_(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 refeased 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 /> EH6 USE ONLY <br /> ***If you need further assistance please contact Diane Martinez direct) @ (209)468-3425. Thank You*,* <br /> GHh 2a.n� <br />