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DATE RECEIVED <br />UNTY <br />R� <br />SAN OHCOJEDENNj!ONMENTALHEAUIN LTH DEPART1111i'NT <br />600 East Main Street, Stockton, CA 95202-2708 <br />NOV 0 9 ZU07 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.o /e <br />ENVIRONMENT HEALTH <br />UTTRT TC"' brr-'n-nYAL, 71TlT in A circ .,,nT 7.ry . rnrr,%r <br />EHD LUG NUMBER <br />PHONE (1): PHOS! <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days tn late f a lication submittal -'Tentative only - must be confirmed) <br />CHECK BOX TO EXPEDITE QUEST - $96.00 FEE SH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT ! DATE <br />Electronic Information: ❑ List ❑ Map —)Description: <br />to <br />FILE ADDRESS <br />EHD USE ONLY <br />FILES <br />Street # <br />Street Name <br />City <br />6 <br />�Ll��'�, r � Unit 1 <br />❑ FOOD FACILITY <br />LI WASTE TIRE <br />F - c ha -fie-r�� <br />s� <br />2• <br />HAZARDOUS WASTE GENERATOR <br />d CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT <br />d . ❑ Unit 2 <br />3. <br />d PUMPER TRUCKIYARDICHEM TOILETS <br />l <br />`\ <br />❑ POOLISPA <br />4. <br />C MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />Unit - <br />5. <br />unit 4 <br />6. <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />❑ Unit 6 <br />10. <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />17 HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITYNEHICLE <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />LI WASTE TIRE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />❑ DOG KENNEL <br />❑ DAIRY <br />HAZARDOUS WASTE GENERATOR <br />d CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY <br />0 MOTEL/HOTEL <br />d PUMPER TRUCKIYARDICHEM TOILETS <br />d TATTOOIBODY PIERCING <br />❑ POOLISPA <br />11 LAND USE APPLICATION SITES <br />C 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 $98.00 deposit prior to review. <br />EHD USE ONLY <br />*** If you should need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You**" <br />EHD 4a-66 311412006 <br />