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DA=tom V LSF EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> EIMRONMENTAL HEALTH DEPART*NT <br /> IN, .t 5 2009 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIRONMENT AMP"':T hone: (209) 468-3420 Fax: (209)464-0138 Web: WWW.sjgov.or <br /> PERMITiSER�Ir.'ES PUBLIC RECORDS RELEASE APPLICATION 4 <br /> APPLICANT: `�� J BUSINESSIAGENCY: <br /> ADDRESS: CITY/STATE/ZIP: <br /> PHONE (1)- O PHONE (2): �2 FACSIMILE. <br /> TENTATIVE*APPOINTMENT DATE:_ SXL_ 3F- 9 I ,J Ji .Time: ? <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE QUE��S-((Trr//1111$115 00 F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN III/ J _ DATE <br /> Electronic Information: ❑ List❑ Map - Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1. <br /> 2. <br /> Unit 2 <br /> 3. - <br /> 4. i <br /> 5 ❑Unit 3 fY) <br /> 6 ❑Unit 4 <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9- veri Ch <br /> Ir <br /> es <br /> 10. }p by r¢Jieoe(,� m.'A- N ernh <br /> H i t0 1 ❑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 /> F]OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY El SOLID WASTE FACILITYNEHICLE <br /> ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ��'7ry'pASTEWATER TREATMENT PLANT <br /> [:1TIERED PERMITTED FACILITY _ ❑MOTELIHOTEL M PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> [:1 TATTOOIBODY PIERCING ❑POOLISPA <br /> E] MEDICAL WASTE FACILITY El LAND USE APPLICATION SITES <br /> ❑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 /> FHM1 IV JY <br /> RMTIMO <br />