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SAN JOAQUIN COUNTY EHD LOGNUMBEF <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> g p 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIRutdlVlciv f HtKLI �leplroQ$ne: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov,Org/ehd <br /> PERMIkMUNMENT HEALTH <br /> I­_ PERMT�I] BLIC RECORDS RELEASE APPLICATION <br /> CjD� <br /> P j BUSINESSIAGENCY: <br /> O �DOn, 02 1 dustrial Way <br /> rY Citylstatealp Lodi, GIC 95240 <br /> �Ju SHO �ti367-�7� PHONE t2): FACSIMILE: <br /> �J LUCDZ TENTATIVE"APPOINTMENT DATE: SIO-10-08 9arn <br /> LL/ Time- <br /> tq j LL-I (Please allow 70 business days from date of application submittal."Tentative only-must be Conflrmad) <br /> U.1 CHECK BOX TO EXPEDITE REQUES .$105 FE (DASH OR CHECK ONLY),REQUEST PROCESSED IN 3 BUSINESS pgyg <br /> SIGNATURE OF APPLICANT DATE 9-26-08 <br /> Electronic Information: ❑List E] Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> ShaBt# Street Name City <br /> 1 9373 N. Hi hwa 99 Stockton o /"l;'0 <br /> ❑ unit' <br /> 3. 9393 N. ighwa�99 .. Stockton Nodbl A10 WI5� ❑ UrIH2 <br /> 3. <br /> 4. Unita <br /> 5. <br /> O� <br /> 6. uult a <br /> 7 <br /> 9• ❑ Unit 6 <br /> 9. <br /> 10. ❑ UnH6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES C <br /> )(UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVENIQLE 4 /'-'"rp• '///[� <br /> ,I <br /> O OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACIuTY 11 WASTE TIRE <br /> yX UNDERGROUND TANK(MONITORINGIREMOVAL)N DOO KENNEL ❑WAST <br /> EDPEHAZARDOUS WASTE GENERATOR ✓, 0 CHICKEN WINCH �WASTEWATER TREATMENT PLANT <br /> Cl DAIRY <br /> TIERED PERMITTED FACILITY C3 MOmLIHOTEL ❑PUMPER TRUCKIYARD/CHEM TOILETS <br /> Cl MEDICAL WAS0DY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY8:0DAM-S:O0PM - EECLUDINGHOUDAYS. <br /> 1. List UP to ten addresses In the space above. Salect the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax ft 1206k464:0138 or mail to the address Indicated above. Address <br /> ranges will net be accepted-for additional asslatance 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 recelpt 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 EMD 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$106 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48.06 8/04/06 <br /> PUBLIC RECORDS RELEASE APP FORM <br />