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1234 KLEINFELDER 11:43:08 03-24-2010 1 ?1 <br /> DATE RECEIVED <br /> %U <br /> SAN JOAQUIN COUNTY EHD LOG N <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> y !1 Telephone: (209) 468-3420 Fax: (209)464-0138 Web; www.sjgov.org/ d <br /> ` N11 61v� 1iT# € l,Tl PUBLIC RECORDS RELEASE APPLICATION <br /> 1 + BUSINESSIAGENCY: <br /> ADDRESS: 1{ <br /> PHONE(1): f77- Z� PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DAT Time: <br /> (Please allow ten business days r date of appli tion submittal_'Tentative on -must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$98 0 E (CASH O HECK ONLY)•REQUEST PROCESSED IN THREE BUST ESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: . ❑List❑ Map-Description: <br /> FILE ADDRESS END USE ONLY <br /> Street# Street Name city <br /> ❑Unit 1 <br /> Unit <br /> nit 3 <br /> 7 - ,. nit <br /> 13. - <br /> - ❑Unit 5 <br /> J. <br /> 0 i7 Unit 6 <br /> Specific Date Range of Information Requested:From to <br /> �J ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> PrUNDERGROUND TANK(UST)CLEANUP SITE(LOP) Ca HOUSING ABATEMENT ❑ <br /> �S3TkiER t'iLEANUP SITE NON-LOP SOLID WASTE FACILITYIVEHICLE <br /> �f- ( ) M FOOD FACILITY ❑WAS E TIRE �1P] i <br /> UNDERGROUND TANK(114041TORINGIREMOVAL)� C DOG KENNEL ❑DAIRYIM— <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH .❑ <br /> ❑TIERED PERMITTED FACILITY( MOWASTEWATER TREATMENT PLANT <br /> 130 TATTOOIBooY PIERCING j JSP A GTEL 13 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASES PECIFY THE SP13 LAND USE APPLICATION SITES <br /> ) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:.00 AM-6:00PM -E%CLUDFNG HOLIDAYS. <br /> 1. List up to ten addresses in the space above. ;elect the type(s)of files from the list above by checking the appropriate <br /> box(es). At least ane file type MUST be selected. Fax to(2091464-0138 or mail to the above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3.00 pm will <br /> be processed the next business day. <br /> 2. The END will notify the applicant if any END files exist. An appointment for review will be confirmed approximately ten <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 the END staff may not be immediately available for review. A new application <br /> may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by END 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 /> END USE ONLY <br /> EHD 48.05 10129)97 <br /> PUBLIC RECORDS RELEASE APP FORM <br />