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OL <br />69/26/2011 11:29 IV <br />5106j�9517 ENVIRON � PP�r,t CI 2' "02 <br />DATE RECEIVED EHD LOG NUi3�R <br />SAN JOAQUIN COUNTY'PI <br />Yn $ <br />r ENVIRONMENTAL HEALTH DEPARTMENT" <br />600 East Main St. Stockton, CA 95202-3029 <br />�� <br />SSP �► 2 �elephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />pER��TjS� PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: smpp I t fJ C J AWP- Lv BUS INESSIAGENCY:__E� V"Qfi <br />ADDRESS: W90LISA�aUA090 Sl I 6TP 30D_CITYISTATEIZIP: <br />PHONE 1):510 2_O - 5 3 PHONE (2): FACSIMI�I,O (O5'<" r [77 <br />TENTATIVE` APPOINTMENT DATE. _ _ Time: <br />(Please allow 10 business days from date of application submittal -*Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT f,]A-_� C�ADATE' Z_ <br />Electronic Information: ❑ List ❑ Map - Description: <br />2. <br />3. <br />FILE ADDRESS <br />EHD USE ONLY <br />-- Unit 1 <br />unit 2 <br />_-- []Unt 3 <br />— --- — - — -- — i— <br />nit 4 <br />❑ Unit 5 <br />Street # <br />Street Name <br />tQ <br />City <br />4• <br />— <br />5. <br />6. <br />7. <br />--- -- -- - - -- <br />— <br />-- --- <br />8. <br />9. <br />2<nityl <br />10. <br />Specific Date Range of Information Requested: From __ _ to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES�> <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ADATEMENT OLID WASTF. FACILITYNEHICLE <br />OTHER CLEANUP SITE (NON -LOP) Q ❑ FOOD FACILITY WASTE TIRE I r <br />UNDERGROUND TANK (MONITORING/REMOVAL) V ❑ DOG KENNEL DAIRY r/ v� <br />T �_3 ' <br />HAZARDOUS WASTE GENERATOR` L] CHICKEN RANCH F1 WASTEWATER TREATMENT PLAN <br />TIERED PERMITTED FACILITY (X ❑ MOI ELIHOTEL ❑ PUMPER TRUCK[YARDICHEMICAL TOILETS <br />❑ <br />TATTOO/BODY PIERCING VOMPLAINT <br />OOLISPA ❑ LAND USE APPLICATION SITES <br />MEDICAL WASTE FACILITY RECORDS ❑ 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 $125 deposit prior to review. <br />r. -.HD USE ONLY <br />EHD 48-06 811/11 <br />