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UOr 1I/GU Uy MUN i3: 4y r'Ax 2U94bb2999 SJC Pubiic Works [6001/001 <br />11 EHD LOG NUMBER <br />�� SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />AUG i .7 2009 600 East Main St. Stockton, CA 95202-2708 <br />'fl HUT�11phone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org4 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: BUSINESS/AGENCY:�OlnI104 V� v1 & ii" Vf <br />ADDRESS: 4�IQ E• i�R2�ij Al CITY/STATE/ZIP: (S�iSC(�t�iury . Ca 5xs— <br />PHONE (1): �� �i(D� - �i�g� PHONE (2):-- FACSIMILE: Xq'7 <br />TENTATIVE*APPOINTMENT DATE: <br />(Please allow 10 business days from date of application submittal -'Tentative only - <br />Time: <br />must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $115.00 FEE (CASH CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />`S J�'�✓/�Fw✓)/L4 i DATE OC3' <br />Electronic Information: ❑ List ❑ Map — Description: <br />From <br />FILE ADDRESS <br />EHD USE ONLY <br />Unit 1 <br />HEALTH DEPARTMENT <br />MOUSING ABATEMENT <br />Street # Street Name <br />City <br />❑ FOOD FACILITY <br />❑ WASTE TIRE <br />UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ DOG KENNEL <br />,>�I <br />P)Unit 2` <br />2. s�se <br />w. c������ �piYlfi � • <br />�1� <br />3- <br />53E <br />rAn C.Iyve <br />t��u _ <br />i..�Ahtr' <br />S '� (u �t�'64nit 3 <br />4. <br />�S1 <br />V r/i63� LE ✓►fin <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />0 <br />_S. F 1 nC ir�O <br />nit 4 <br />6 <br />0 �l7 <br />�t <br />11Cs�t%� <br />p �aa�� <br />Nrn.�v<K <br />7. <br />! 55.1 �V <br />VV, 61 ra n <br />❑ Unit s <br />W. YAF)- <br />{� <br />9. <br />S i xii &+• <br />� ►i <br />Unit6 <br />10. <br />� � <br />�. (�v-anf L Nkie-M. <br />Specific Date Range of Information Requested: <br />From <br />to <br />ENVIRONMENTAL <br />JE�UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />HEALTH DEPARTMENT <br />MOUSING ABATEMENT <br />FILES <br />❑ SOLID WASTE FACILITYNEHICLE <br />, ®• THER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ WASTE TIRE <br />UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ DOG KENNEL <br />ElDAIRY UP <br />c&HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT ��� I�Q� <br />❑ TIERED PERMITTED FACILITY <br />❑ MOTELIHOTEL <br />PUMPER TRUCKIYARD/CHEMICAL TOILETS <br />❑ TATTOoIBODY PIERCING <br />❑ POOLISPA <br />�ND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <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 />LHU USL ONLY <br />***If you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br />-- -- <br />cHn en -4F -__--- <br />