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DC,E_1y9�� nFD EHD LOG NUMBER <br /> 4 (((���"�iLLll��_�-- 1`,J(I SAN ,IOAQUINCOUNTY <br /> E% _(ONMENTAL HEALTH DEPARTNICNT <br /> FEB 0 9 2010 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIRONMENT HEZ9 <br /> hone: (209) 468-3420 Fax: (209) 464-0138 Web: WWW.sjgov.org hd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ,)t55yllal�l� t-, BUSINESSIAGENCY: �� S /�jOjrnC <br /> ADDRESS: 5-S' q�Wn_!/ 5h CITYISTATEIZIP: 0-2o Z <br /> PHONE (1): 2b (A7(a cjj PHONE (2): FACSIMILE: �bGiu07 —o(Z <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-$115.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> 1 SIGNATURE OF APPLICANT DATE 2 �� 6 <br /> Electronic Information: ❑ List❑VAap—Description: <br /> \ FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city El Unit 1 <br /> ties, <br /> 2 .15b fi '� 1 ( `J LgG(c U T OZ 1 PAi QCS. Unite \� <br /> 3. <br /> 4. <br /> 5 Unit 3 '� <br /> 6. <br /> nit 4 <br /> 7. <br /> 6. <br /> ❑ Unit 5 <br /> 9. <br /> 10. <br /> Uni[6 <br /> Specific Date Range of Information Requested: From -111160 to /pN- ri <br /> ^^,,�� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> EYuNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ��/ LID y <br /> ❑OTHER CLEANUP SITE NON-LOP L'7 WAST WASTE FACILRYNEHICLE <br /> ff,�,/ ( ) ❑FOOD FACILITY WASTE TIRE <br /> ,�-4,,U//NDERGROUND TANK(MONITORINGIREMOVALK ❑DOG KENNEL ❑DAIRY /(J �//��,, ��// <br /> WAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH rrxf�� Yr✓/yl(ck <br /> TIERED PERMITTED FACILR MOTELMOTEL 1=J PUMPER TRUC TREATMENT PLANT <br /> ❑TATTOOIBODY PIERCING ❑ ❑LANDU E APPLICATION <br /> SITESAL TOILETS <br /> ❑POOLISPA F1 LAND USE APPLICATION SRES <br /> ❑ 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$115.00 deposit prior to review. <br /> 1 Ma.>• ONLY <br /> ***If you need further assistance le a contact Diane Martinez direct) @ (209)468-3425. Thank You*** <br /> - Ila) ,10: <br /> - 0 <br /> l '- y n <br />