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uH{t{MMIVI E Iy SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> �I�U�I-]JU�1)� I� ll LL��F Ek41RONMENTAL HEALTH DEPARAftT <br /> (Ni. °4 5 2009 600600 East Main St. Stockton, CA 95202-2708 <br /> ENVIRUIVMYTH�Rjy phone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.or <br /> 4lMq <br /> PERMITISERVME'S PUBLIC RECORDSRELEASEAPPLICATION <br /> APPLICANT: J BUSINESS/AGENCY: v <br /> ADDRESS: CITY/STATE/ZIP: <br /> PHONE (1) �Q PHONE � FACSIMILE. i27 C <br /> TENTATIVE*APPOINTMENT DATE: s[L ©F' 9 3 � ' Time: <br /> ` <br /> (Please allow 10 business days from date of appl�catlon submittal-'Tentative onl must be confirmed) <br /> ❑CHECK BOX TO EXPEDITEMQUEST1500 F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANj - DATE A d - <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City _ <br /> 1 ❑Unit 1 <br /> 2. <br /> 3. <br /> 4. <br /> 5 ❑Unit 3 <br /> 6. <br /> ❑Unit 4 I <br /> 7. <br /> 8. <br /> ❑Unit 6 <br /> 9. Vefl Co i fo G)1 e� mo <br /> 70. ler, i-0 be- teJieWM M.A N ErrT <br /> ttl1to1g, ❑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(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> 171 TIERED PERMITTED FACILITY - ❑MOTELIHOTEL PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑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 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 /> END USE ONLY <br /> ***If you need further assistance Please contact Diane Martinez direct) @ (209)468-3425. Thank You*** <br /> LHII eAJYf <br />