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DA EHD LOG NUMBER <br /> (--) SAN JOAQUlN COUNTY t <br /> EN-. RONMENTAL HEALTH DEPARTIIW NT <br /> IV.- �'j 5 2009 600 East Main Si. Stockton, CA 95202-2708 <br />' <br /> gt%pone: (209} 468-3420 Fax: (209) 464-0138 Web: www.sjgOV.Or <br /> PERMITiSMVf r. PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: !�.-J <br /> BUSENESSIAGENCY: U <br /> ADDRESS: CITYISTATEIZIP: <br /> PHONE (1)- Q PHONE (2): FACSIMILE. <br /> �/ t <br /> TENTATI VE*AP POI NTMENT DATE:��i�_ I qTirne: 47 <br /> (Please allow 10 business days from date of application submittal-*Tentative on -must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE QUEST-$1150 F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN BUSINESS DAYS <br /> SIGNATURE OF APPLICAN j _ DATE <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> ❑Unit 1 <br /> 2. <br /> 3. Unit 2 <br /> 4. II <br /> ❑Unit 3 � <br /> ❑ Unit 47. <br /> 8. <br /> ❑Unit 5 <br /> s. <br /> 10- k II✓s fo be- (-ev�ewIch <br /> L - N nh ct I <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 A13ATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY <br /> F-1UNDERGROUNDTANK(MON[TORINGIREMOVAL) ❑DOG KENNEL El WASTE TIRE <br /> ❑HAZARDOUS WASTE GENERATOR ❑DAIRY <br /> ❑CHICKEN RANCH_ ASTEWA7ERTREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL MPUMPERTRUCKNARDICHEMICALTOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA- <br /> DM EDICAL,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:OOPM(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 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 /> you need further assistance please contact Diane Martinez directly (209)468-3425, Thank You*** <br /> FHfI dH11F <br />