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DATE RELINED <br /> EHD LOG NUMBER <br /> �j., i— -1 . i I I SAN JOAQUIN COUNTY <br /> U ENVI*NMENTAL HEALTH DEPARTMIE <br /> !IPF d j 2008 Telephon600 East Main Street, Stockton, CA 95202-2708 <br /> e: (209)468-3420 rax: (209)464-0138 Web: WWW.sjgov.org/eh <br /> ENVIRON ii-'EN T HVilrh <br /> PERngi'�/tS��=eyic€r PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:t2w(p (��t`�3�(r�I� BBU`SINESS/AGENCY:LINE 17 pESIC� <br /> ADDRESS: !'f^7O2Ci� C ZE29 <br /> PHONE(1): 4 L C���ti p PHONE(2): 4-7 J -'Z 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 UEST-$9 00 FPCA@H OR CHECK ONLY)-REQUEST PROCESSED IN 3 USIN SS DAYS <br /> SIGNATURE OF APPLICANT DATE ZI <br /> Electronic Information: ❑ List Ej4Map—Description. <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑ Unit 1 <br /> 1. crc19za Lo <br /> 2. ❑ Unit 2 <br /> 3. <br /> 4 Unit 3 <br /> 5. 1a <br /> 6. Unit 4 TI <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 19 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> BOTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> ISf UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> XI HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH OWASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> 13 TATTOOIBODY PIERCING ❑ POOLISPA O 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 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. Anyfiie 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> *** If you should need further assistance please contact Diane Martinez C (209)468-3425 directly. Thank You*** <br /> EHD 4846 9114]2(XE <br />