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___---"41Y-17-2013 01 :39 PM "-ETON SOLUTIONS 1 593 3800 P - 01 <br /> DATE R,E�. � <br /> �( 'MWTEDD SAN JOAQUIN COUNTY FHDL�i"ER <br /> `�� 5 ENVIRONMENTAL HEALTH DEPARTMENT e <br /> clli� 600 East Mein St, Stockton CA 95202-3029 <br /> ti', 1 7 Telephone: (209) 468.3420 Fax: (209) 464-0138 Web: www,Bjgov.org/eh <br /> ENVIR(ii IOEN'l HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_Jsce "4 BU91NES$IAOENCY: <br /> ADDRESS: _ /x•3,5/ SAIA>. l74l CITY/STATEtZIP: Piftr�C/; <br /> PHONE(1): ��/l-S`J,?- , BOb PHONE (2): -5q/- /- -1377 FACSIMILE: <br /> `yc)b <br /> TENTATIVE'APPOINTMENT DATE:��;p Time: <br /> (Please allow 10 bueiesss days from eaa of applloatloe submittal•• e vb only.moat pe oonnrmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ~ _ DATE s/, <br /> Electronic Information: ❑Llet❑Mep-pee ptlon: <br /> FILE ADDRESS 1HD Y <br /> Street a LLStreet Name city Unit 1 <br /> 2. <br /> nit 2 <br /> 3. <br /> 4. ` r <br /> 6. <br /> Unit a <br /> e. <br /> unit 4 <br /> 7. <br /> S. 171 <br /> Unit e <br /> 10. <br /> unite <br /> Specific Date Range of information Requested: From hLL to r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILER <br /> NOERGROUtID TANK(USI)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYNENICIF L / <br /> THER CLEANUP SITE q(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> NDEROROUND TANK(MONLTORIN REMOVAL) ❑DOC KENNEL ❑DAIRY,MH <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER I REATMENT PLANTZy�O <br /> TIERED PERMITTED FACILITY/ ❑MOTEIIHOTEL ❑PUMPER TRUCKNAROICHEM ICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA NAND 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•6100PM(EXCLUDING HOLIDAYS) <br /> 1. List up to hon addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(ss). At least one file type MUST be selected. Fax to(2091484.0135 or mall to the address indlcatad above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHO. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHO films 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 now application may be <br /> submitted when the ftle is available. <br /> 4. Any flle not returned In the"me 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$118 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)485-3426. <br /> Y <br /> ,p;;;. � Er,- l . ,SCO <br /> U" <br /> !X � a <br />