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l Q 0 EHD LOG NUMBER <br /> SAN JOA UIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT r <br /> NOV 13 2008 600 East Main St. Stockton, CA 95202-27081 <br /> Telephone: (209)468-3420 Tax: (209)464-0138 Web: www.sjgov.org/chd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: zz -- �.L -otj BUSINESSIAGENCY: <br /> ADDRESS: �SO I - C-OG)�,TY2,t w vI CITY/STATEIZIP S7 C-KC 7P1,) CppJ//�. <br /> PHONE(1): � F—3_ PHONE(2): FACSIMILE: OVUi!!' �3S <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 REQUEST�05.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 313 SINESS DAYS <br /> SIGNATURE OF APPLICANT - =�f� DATE /'3�od' <br /> Electronic Information: ❑ List❑ Map- Des�cription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑ Unit 1 <br /> 1. 3oll W, &-lJ_grl) .N l-faLT' UK SiU,f�TD�) o2% <br /> 2 ❑ Unit 2 <br /> 3Ole <br /> 4. Unita <br /> 5. 09- - <br /> 6. <br /> ❑7. Unit 5 <br /> 8. <br /> 9. <br /> ___ ❑ units <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT O SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOOBODY PIERCING 0 POOL/SPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDSARE AVAILABLEFOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:OOPM - 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 />