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209+333+6792 CITY OF LODIR 09:S a.m. 10-06-2010 111 <br /> DATE RECEIVED IV �� ry EHD LOG NUMBER <br /> I(TI^�J,1, In`IED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> u(-'f n 70I0 600 East Main S . Stocton, CA ephone: (209) 468-3420 Fax; (209)k464-0 38 We 30wwwsjgov.orgaehdj6D <br /> 29 <br /> ENVIRo)vl�'r�ra� HEALfi� <br /> Ppga�SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: fSM.2e�,r BUSINESSIAGENCY: pec�c� j>3�PA,e.htr,�lj <br /> ADDRESS: co. &Zot S'7 CITYISTATEIZIP: L!f'D / C,4 <br /> PHONE (1):)v q •33 3-6 8e u? we-6 PHONE(2): FACSIMILE:209' 333' 10 9 L <br /> TENTAT/VE`APPOINTMENT DATE: Time <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must he confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUES 2 F ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE /0--6 <br /> Electronic Information: ❑List❑ Map–Description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street <br /> # Street Name City nit l <br /> 1. CJc <br /> 2• tit 4Z- <br /> ❑Unit 2 <br /> 4. ESC—,4- / _ — -{'.} ,/(�. _ ❑Unit3 <br /> 6. ' Unit 4 <br /> 7. ,- <br /> (1/}`/`-', ❑ <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit <br /> Specific Date Range of Information Requested: From JfrL✓.1-r�7 �l C7 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(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARD/CHEMICALTOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LANA 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:OOPM(EXCLUDING HOL(DAYS) <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to to 1209)464-0138 or mail to the address indicated above.-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$122 deposit prior to review, <br /> END USE ONLY <br /> EHD 4SA6 <br /> e11I9110 <br />