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OCT/25/2010/MON 05:05 PM BANK OF THE WEST FAX No, 2094783457 P, 001/001 <br /> �D SAN JOAQUIN COUNTY EHD LOG NUMBE• <br /> Uf;C L 5 L'010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> ENVIRONMENT HEAffblephone: (209) 468-3420 Fax: (208)464-0138 Web: www.sigov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION JJJ <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: �e 9 � 1 <br /> PHONE (1):Q-a'-k( O ( '-�_7 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 /> ❑CHECK BOX TO EXPEDITE REQUE&T1%122 FE O E NLY)-REQUEST PROCESSED IN 3 0US NESS AYS <br /> SIGNATURE OF APPLICANT` / (( DATE a <br /> Electronic Information: ❑ List ❑ Map-Descriptlon: <br /> FILE ADDRESS EHD USE ONLY 1 <br /> Street# Street Name City Unit 1 J\ <br /> 1. <br /> 2, El <br /> Unit a <br /> 3. <br /> 4. ry <br /> Unit S � <br /> 5. <br /> 6- P <br /> Unit 4 <br /> 7. <br /> B. <br /> ❑Unit 5 <br /> 9. 1 <br /> 10. ❑Unit s / <br /> Specific Date Range of Information Raquestad: Fromc�! to I �I <br /> ENVIRONMENTAL}1EALO DEPARTMENT FILES <br /> X6UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WAsfEFAcjuTYIVEHICLE 11�, <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE tM <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVALK ❑DOG KENNEL ❑DAIRYko <br /> AZAROOUSWASTE GENERATOR E]CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT \O,Z� <br /> ❑TIERED PERMITTED FACILITY ❑MOTELfHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY 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:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List un 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. Pax to(209)484-0138 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 this next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately tan (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 EHD staff may nat 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 EMD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> EHD USE ONLY <br /> 5 <br /> S <br /> On <br /> EHD 484G 0712S110 <br />