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NOV-27-2012 08:06 Martin & Associates 904 674 6316 P.01/01 <br />1RObVE <br />EHD LOG NUMBER <br />SAN.IOAQUIN COUNTY w <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />NOV 27 2012 600 East Main St. Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br />PERMITfSE, 1.16-0 <br />dV� <br />0 <br />APPLICANT: Carol Wheeler <br />BUSINESS/AGENCY: Martin Environmental <br />ADDRESS: 8823 San Jose Boulevard Suite 103 CITY/STATEIZIP:Jacksonville FL 32217 <br />PHONE(1): 904-737-1034 PHONE (2): 904-437-2417 FACSIMILE: 904-674-6316 <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 RECIMEST - $115 FEE (CASH OR )?,H, ECK ONLY) - REOUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT Y DATE j / •,;27_ j,�2 <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Unit 1 <br />Street # <br />Street Name <br />City <br />1 <br />1153 <br />Vanderbilt Circle <br />Manteca <br />7l% I <br />❑ Unit 2 <br />2. <br />3. <br />Unit 3 <br />4• <br />S. <br />Unit 4 <br />6. <br />7. <br />E] Unit 5 <br />9. <br />L10.8. <br />❑ Unit 5 <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES - <br />�}iJNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACIL NEHICL�E^ ) ��� <br />OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRESV ��X.,'5LIlir L401I I - <br />,ZUNDERGROUND TANK (MONITORING/REMOVAL)04 ❑ DOG KENNEL ❑ DAIRY Y%/.i1 tl )j_ 3LX (-?_ <br />-Rj-HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />-94IERED PERMITTED FACILITY 0�, ❑MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ TATTOOBDDY PIERCING ❑ POOLISPA ❑ LAND 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-5:00Pm (EXCLUDING HOLIDAYS) <br />1. List up to ten addresses in the space above. Select the types) of files from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (2091464-0138 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 rile 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) 468-3425. <br />FXtt l ISF nNl Y <br />IDIOM �Mlllllffl. Mg. "MM10 <br />Illymm IRS ON F, <br />EHD 4e-06 X121103 <br />Received Time Nov. 27. 2012 5:19AM No. 1695 Total P.01 <br />7 <br />