Laserfiche WebLink
01/11/2005 20:44 9169663290 DELTA F—, �E 01 <br /> pay -- <br /> CEN <br /> DATRVE�L3* 2, +t 11 EHD LOG NUMBER <br /> VU Y SAN JOAQUIN COUNTY <br /> ENVIRONMENTALHEALTH ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main S . CA 95202- 029 <br /> pERMITISERVIC a ephone: (209)468-3420 Fax: (209)k464-0 38 Web; ww.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: MATT SMALLEY RUSINESS/AGENCY: ANTEA GROUP <br /> ADDRESS: 9241 LA SERENA DRIVE CITY/STATE2IP:�FAIR OAKS <br /> PHONE(1): 916 966 3290 PHONE(2): FACSIMILE: 916 638 8365 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> IPlesaa allow 10 buoinese days fromdate of appllcatlon submlttal- ranfavva only-must be conflmhed) <br /> Q CHECK BOX TO EXPEDITE REQUEST-$115 F fCA$H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE_ <br /> Electronic Information: ❑List O Map- ascription: <br /> FILE ADDRESS EHD USE ONLY <br /> D 9teeta Street Name City <br /> 1,T 1206 E MARCH LANE 5TOCKTON-......._. u!V G S/ <br /> 2. <br /> 3. <br /> 4' Unit 3 <br /> 5. \ <br /> 8. <br /> ❑Untt 5 <br /> 91 <br /> 10. ❑unit Q <br /> Specific Dam Range of Information Requested: From ALL to PRESENT <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 'r <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT L�-'+�SOLID WASTE FACIurYNEHICLE J <br /> []OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY LJ WASTE TIRE <br /> [�UNDERGROUND TANK(MONITORING/REMOVAL)X ❑DOG KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR( CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ®TIERED PERMITTED FACILDVI�, ❑MOTELIHOTEL I-]PUMPER TRUCKIYARDICHEMICAL TOILLTS`� <br /> Q TATroof8oDY PIERCING []POOLISPA ❑LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REvIEw: MONDAY-FRIDAY 8:00 AMS:00pM(EXCLUDINe 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(2011444.0139 or mail to the address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EMD will notify the applicant If any EHD tiles 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 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)400.3429. <br /> HIa Use ONLY <br /> kT10 aaAB <br />