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DARMp� V Lam. SAN JOAQUIN COUNTY EH-Ea.l.f3GA IBER <br /> E4WIkONMENTAL HEALTH DEPARTM�WT <br /> N, -15 2009 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIRUNIbitNTMEt� � <br /> T hone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.or <br /> PERMIT/Sim v PUBLIC RECORDSRELEASEAPPLICATION <br /> APPLICANT: "PHONE <br /> `� �J BUSINESSIAGENCY: <br /> ADDRESS: CITYISTATEIZIP: <br /> PHONE (1)- - (2): FACSIMILE. <br /> TENTATIVE*APPOINTMENT DATE: CF- 9-1 3I l Time: <br /> (Please allow 10 business days from date of application submittal-•Tentative onl -must be confirmed) <br /> ❑CHECK BOX TO EXPEDITEQUEST-$115 00 F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN 'VjzmDATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City - ❑Unit 1 <br /> 1. <br /> 2. <br /> V41t 2 <br /> 3. <br /> 4. <br /> ❑Unit 3 <br /> 5• v_ <br /> s. <br /> ❑Unit 4 I� I <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. Vett wif Carl fO all 8 trio t3S <br /> 10. riiter +Obe- CedteVed m.A- N 2rrlb <br /> ll tl0( ❑Unit6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SRE(LOP) ❑HOUSING ABATEMENTSOLID <br /> ❑OTHER CLEANUP SRE(NON-LOP) ❑FOOD FACILITY ❑WAST TIRE FACILITYNEHICLE <br /> ❑UNDERGROUND TANK(MONrrORiNGIREMOVAL) ❑DOG KENNEL ❑WABTE TIRE <br /> ❑HAZARDOUS WASTE GENERATOR DAIRY <br /> ❑CHICKEN RANCH �n/�yASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL M PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA <br /> ❑ MEDICAL 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-5:00PM(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 fora 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 <br /> -'ONLY <br /> ***If you need further assistance please contact Diane Martinez directly @ (209)468-3426-.—Thank You*** <br /> FHA IMM. <br />