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�. � alP 1 ! ( WED ) MHR <br /> ROMIN I <br /> LEI o zo , D , z T , z ss .W �seDDDo3z , P <br /> C IV _D 194 ' EHD LOG NUMBER <br /> 'X EHD <br /> SAN JOAQUIN COUNTY <br /> MAR 1 U 2010 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENUIRUNIU;ENT HEALTH 600 East Main St, Stockton , CA 95202-3029 <br /> PERMIT/SERVICES Ve T°ne : (209) 468-3420 Fax: (209) 464-0138 Web : www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION nn ' r0� <br /> APPLICANT: etJ ! c Q BUSINESSIAGENCY: Fi�h �nVirwnme4 <br /> ADDRESS: 1333 p s c ITY/STATE/ZIP: e <br /> +--rte � - L <br /> PHONE ( 1 ) : SIS-eLN ] -q8 O 2pHONE (2) : FACSIMILE:316 - Sf} <br /> TENTATIVE' APPOINTMENT DATE: Time : <br /> (Please allow 10 business days from date of application submlltB Tti-¢M Iii m only . must be confirmed) ' <br /> CHECK BOX TO EXPEDITE REQUEST - $115 F AS OR CHECK ONLY R[=y1113E^T PROCESSED IN 3 BUSIIVE3S Dg <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List ❑ Map - Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street # Street Name City ❑ Unit 1 <br /> 2. W � , i' ntnvti� JQ' CQ J On I - _` `;t- !,, ❑ Unit2 \`v <br /> a. ;LEDy3 �� s /l< da F <br /> 4' 0 C) 1^ LES c� Ute. __ `Y --; - Unit 3 <br /> 6. <br /> 8 . , <br /> - - Unit 5 <br /> 9 . : a ' e,: <br /> v <br /> 10, F. <br /> ❑ Unit 6 <br /> Specific Dale Range of Information Requested: FroaO to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT [_1 SOLID WASTE FACILITYNEHICLE <br /> HER CLEANUP SITE (NON-LOP) ❑ F000 FACILITY ❑ WASTE TIRE <br /> A UNDERGROUND TANK (MONITORING/REMOVAL) El DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br /> ❑ TIEREO PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND 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•5:00PM (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 rove 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 deposit prior to review. <br /> 5. If you need further assistance, please contact Diane Martinez, at (209) 468-3425. <br /> EHD USE ONLY <br /> EHD da-06 SQ]/Da <br />