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01/15/2010 15:00 714508e'91 GDLDER ASSOCIATE" <br /> DATE RECEIVED PAGE 01 <br /> SAN JOAQUIN COUNTY `' EHDLCGNUMBER <br /> If1]L�I�JI�LI Vr�D ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, 01 8 5203029 JA.N 1 5 ZOIOTelephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjg 7/3 <br /> E (�iSE HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; <br /> BUSINESSIAGENCY: �p)rl r cnc ? k-,c <br /> ADDRESS; V <br /> PHONE (1): CITY/STATE/ZIP:L{_ SDR_-- * 1Hn�, PHONE(2): <br /> TENTAT/VE'APPOINTMENT DATE: FACSIMILE:�LS�g (� ( <br /> (Please allow 10 business days from date of appllcatlon submittal-'Tentative only Time: <br /> CHECK BOX TO EXPEDITE REQUEST <br /> y-must be con£rmed) <br /> Q -$_115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE_ i /S <br /> Electronic Information: ❑List ❑ Map—Description: <br /> FILE ADDRESS END USE ONLY <br /> Street# Stnet Name city <br /> �vet�vtr,_ 1 <br /> 2. '�t'- <br /> 3. _ Unit <br /> a. - �� <br /> 5. Unit 3 <br /> 6. <br /> 7nit 4 <br /> 8. <br /> 9. ❑Unit 5 <br /> 10 <br /> d6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUNDTANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLD WASTE FACIUTYIVEHICLE <br /> TRER CLEANUP SITE(NON-LOP) FOOD FACILITYJF WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEUHOTEL <br /> PIERCING <br /> TATTooffio Y PUMPERTRUCIWASI MICALTOILETS <br /> ❑POOUSPA AND USE APPLICATION <br /> K)N SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL MND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW; MONDAY-FRIDAY S:Oo AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type(s)of Tiles from the list above by checking the appropriate <br /> box(es). At least one flle type MUST be selected. Fax 9 484-0138 or mail tn tko addre dlcated abgve, Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. Applications recelved after <br /> 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant if any END files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies will behold 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 END 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 END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez.at(209)468-3425. <br /> Eno est ONLY <br /> EHO M-06 <br /> l27fog <br />