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EHD LOG NUMBER <br /> D 7r[Tffr <br /> � SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> DEC 0 9 2008 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIRONMENT HEALTH Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/eh <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: v� �-(J `)S BUSINESS/AGENCY: �" <br /> ADDRESS: Z� ► �4"�I` `R CITY/STATE/ZIP � t� �tT �Z Z <br /> PHONE(1): 24 l I SII SZ PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> 171 CHECK BOX TO EXPEDITE REST-5105.00 EE(CAS OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT a DATE ( UCW"', <br /> o', <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 2' ��� (o o I` Z��{�Z f? , 4 ❑ Unit 2 <br /> 3. - — <br /> 4. �K/� - U51 cU(J� Unit <br /> 5. <br /> 6 Unit 4 <br /> 7. <br /> 8 ❑ Unit 5 <br /> 9. <br /> ---- --- El 6 <br /> 10, <br /> Specific Date Range of Information Requested: From _ C to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES r <br /> v IVNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT 11 SOLID WASTE FACILITY/VEHICLE (� <br /> ED'OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE F� <br /> UNDERGROUND TANK(MONITORING/REMOVAL ❑ DOG KENNEL ❑ DAIRY r-Z' zl'T <br /> C3 HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 13 MOTEL/HOTEL M PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> 0 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 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$105.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br /> 1 0Jt LA) <br /> LAlkL <br /> r'f (_P(&,- <br />