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n0�222/�05/2010 15:03 9168610gi0 STANTEC PAGE 01/01 <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ll�ii UUU LLL`'" ���JJJ ENVIRONMENTAL HEALTH DEPARTMENT �} <br /> FEB 0 5 2010 600 East Main St. Stockton, CA 95202-3029 '/r <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.orgfehd 4L/_ <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION {�� <br /> P GAG <br /> APPLICANT: f BUSINESSIAGENCY: ft4p rV f' CO <br /> ADDRESS: �� fOad, tJ08 CITYISTATEIZIP:_ ,,". /�111i� <br /> PHONE(1): - PHONE(Z): FACSIMILE; y - <br /> TENTATIVE"APPOINTMENTDATE: G 2,Z dip Time, <br /> �Q�d� <br /> (Please allow 10 business days from dais of app cation aeNmittal-"Tentative only•must he cvnnrmed) <br /> ❑CHECK BOX TO EXPEDITE REQUE $115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU INyr,SS DAYS <br /> SIGNATURE OF APPLICANT DATE .r t 0 <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Strer4 �4 <br /> city Unit1 <br /> 1 yPoe on 'T <br /> z. ly y 5"fackfo# f_� unit23. ��( lite ea <br /> 4. <br /> 5. nit3 \ <br /> T6. <br /> T. nit a <br /> 8. <br /> 9 ❑Units <br /> 10. <br /> F-_ ❑ubhe <br /> SpecRic oats Range of Information Requested: From <br /> to re <br /> �fvII ENVIRONMENTAL HE LTH DEPARTMENT FILES <br /> ,cv UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILUYNEHICLE <br /> ER CLEANUP SITE(NON-LOP) ❑Fool)FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ©DOG KENNEL <br /> HAZARDOUS WASTE GENERATOR E]DAIRY <br /> ❑CHICKEN RANCH E]WASTEWATER TREATMENT PLANT <br /> ❑%RED PERMITTED FACILITY ❑MOTEUHGTEL <br /> ❑TATTOGIBODY PIERCING - ❑PUMPER TRUCKICATION SI MICALT01LET5 <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(A ❑LAND USE APPLICATION SITES <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to fen 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 f209)464.0138 nr Mail to the adgress indicated a0pye. 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 mcelpt of application. The files will be held for a maximum of rive business days for review. Appointments <br /> should be scheduled accordingly. <br /> Z. 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 atthe expense of the applicant. <br /> Future file reviews by the same applicant may require a$116 deposit prier to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)466.3425. <br /> EHb DSE DNLY <br /> END44Ae <br /> Ei3TNa <br />