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From:Kleinfelder 209 575 3444 08 2011 10:48 122 P.001/001 <br />REU.IV �., <br />SAN JOAQUIN COUNTY [iib LOG NUMBER <br />ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH DEPARTMENT <br />PERNMEN AL ES 600 East Main St. Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />ADDRESS: <br />BUSINESS/AGENCY: <br />CITYISTATE/ZIP: <br />PHONE (1): j 77-�3n PHONE (2): FACSIMILE: 7 -� <br />TENTATIVE"APPOINTMENT DATE: Time: <br />(Please allow 10 business days from d t of pplication ubmittal - *Tentative only - must be confirmed) <br />❑ CIAECK BOX TO EXPEDITE REQUEST - $122 F E (C SH OR C CK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT__y — DATE <br />Electronic Information: ❑ List E] Map'- Description. <br />—_ —_ <br />__,__ FILE ADDRESS EHD USE ONLY <br />Street # <br />— <br />Street Name City <br />____�c� <br />�-Unit 1 <br />2. �a0 <br />-- <br />--_v�ct�Q� <br />unit <br />, -2- <br />— — - --- ----------- ---------- <br />.Unit 3 <br />------------------- <br />--- ------------- <br />-- — -- --- — <br />4 <br />9q7.Unit <br />C�a� <br />— <br />5W CtA1 I fC <br />El Unit 5 <br />snariAr <br />n�+o o�.,..� ..a <br />�s.........: <br />Unit 6 <br />.............yam ... nno mauvn Requested; From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />�- <br />iUl;R <br />RGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT OLID WASTE FACILITYNEHICLE <br />L�� CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ASTE TIRE <br />,L✓ -,j UN�RGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL AIRY <br />L7t1AZAR000S WASTE GENERATOR ❑ CHICKEN RANCH CRWASTEWATER TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL <br />❑r-���.,P.,U�M,,P�ER TRUCK/YARD/CHEMICAL TOILETS <br />❑ TATTOO/BODY PIERCING ❑ P00 PA tP AR USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY THER (PLEASE SPECIFY) b(r�tY��`` <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM OOPM (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 END staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $122 deposit prior to review. <br />