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DFl�j !•.n � SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ({v' Et"fRONMENTAL HEALTH DEPARTI ENT <br /> (� 'j 5 2009 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIR[ANIENTHEXtjrp,rie: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.or <br /> PERMITiSERVIrES t PUBLIC RECORDSRELEASEAPPLICATION <br /> APPLICANT: J BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: <br /> PHONE (1)- - Q PHONE (2): 5 FACSIMILE. <br /> TENTATIVE"APPOINTMENT DATE: —13 I IjTime: <br /> (Please allow 10 business days from date of application submittal-*Tentative on[ must be confirmed) <br /> ❑CHECK BOX TO EXPEDITEMQUEST- 15 00F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESSDAYS <br /> SIGNATURE OF APPLICANj - DATE l <br /> Electronic information: ❑ List❑ Map — Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> _ E l unit 1 <br /> 2. <br /> 3. _ __Unit 2 <br /> 4. I Q <br /> 5 ❑Unit 3 <br /> 6. <br /> ❑Uttit 4 <br /> 7. <br /> 8. <br /> ❑Unit 6 <br /> 9• Veil Gh C 10 <br /> 10. F',Ie.'; +oj Icr- fe\/e:,. ej m A- N e M t t It to <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 ❑SOLID WASTE FACILITYNEHICLE MONITORINGIREMOVAL WASTE TIRE <br /> UNDERGROUND TANK <br /> ( ) El DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH E])ASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL MYUMPERTRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA <br /> ❑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 unto 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 /> ***If you need further assistance please contact Diane Martinez direct) @ (209)468-3425. Thank You*** <br /> Cop 6pM <br />