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1r onmrt nl , In. . rill-n)HAIi IU 9010 13111@/6T. 141 DA/Nn, 7400CIIlOn41 I' I <br /> r+j 4111111111" kHUIUUNVIIII <br /> SAN JOAQUIN COUNTY <br /> MAR I U 2010 �!:, ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 J } <br /> ENVIRUNlV;tIVT HEALTH t one: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd (l fU,j <br /> PERM/SERVICES � �' <br /> PUBLIC RECORDS RELEASE APPLICATION ( Q <br /> APPLICANT: 0L1 S4 C- Q BUNESSIAGENCY: !i9nV IbnnenYt� <br /> ADDRESS: IS33 6 S c I� �,et' ATE/ZIP: at)U.'k l� . <br /> n� r—baa 7- <br /> PHONE(1):SIO'1U7-g885'x.36aHONE(2): CSIMILE:316 '88 `S3 <br /> TENTATIVE'APPOINTMENT DATE: 3- -1 ,,4 n# T' e: <br /> (Please allow 10 business days from date of application submittal•'Tents I a confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-s1155FFESAS OR CHECK ONLY,-REQUEST PR •' SSE D IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT / DATE <br /> Electronic Information: ❑ List❑ Map–Description: <br /> _ FILE ADDRESS EHO USE ONLY <br /> St/re1et/ Street Name City [3 Unit t <br /> / 2. � 6S0 F-, � ntrty� SV roe S an2 r�- ❑Unit2 v <br /> �r 3' �-bt4 Fr <br /> 4. <br /> 5' gSC¢ri <br /> 6' /Unit <br /> 7. <br /> .vf <br /> El unit 5 <br /> 9. ---- <br /> - --- <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE + i <br /> THER CLEANUP SITE(NON-LOP) F1FOOD FACILITY [IWASTE TIRE �f 1 <br /> ,UNDERGROUND TANK(MONITORING I EMOVAL)� El DOG KENNEL El DAIRY <br /> I �I I zIl <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOBODY 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 len 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 END. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant K 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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468.3425. <br /> ENO USE ONLY <br /> em 09 <br /> END 48-e6 <br />