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11- 4-09: 7:39AM;Dent Of Conservation <br /> n ;916 322 4862 9 �! � <br /> 4 <br /> [WOENED � SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> NUV 2009 ENVIRONMENTAL HEALTH DEPARTMjIRi© p e <br /> 600 East Main St. Stockton, CA 95202-302 <br /> ENVIRQI� IEN�MEA�. Iephone. (209)468-3420 Fax: (209)464-0138 Web: www,sjgov.org/e <br /> vjf <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:1sEjtlis) �21tpjY BUSINESS/AGENCY: <br /> ADDRESS: 1301 St <br /> -O CITY/STATE/ZIP:�C1bg,,yt6Mn 1 G� qs4,i�{--35'34 <br /> PHONE(1): q b - 3-2-V PHONE(2): t1IS _�-/9 aS FACSIMILE: /6 AL2 j <br /> TENTATIVE*APPOINTMENT DATE: AJO V6W rGL Time, <br /> (Please allow 10 business days from date of application subml al-'Tenrarive only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$11 FE C 5H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT - DATE <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> ©Unit 12. <br /> _ <br /> 3. � tit5tt 2 >� <br /> 4. <br /> S I]Unit 3 <br /> 6. <br /> 7. — ❑Unit 4 <br /> 8. <br /> 9 ❑Unit 5 <br /> I]Unit 6 <br /> ,Specific Date Range of Information Requested. From to —.2C69 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FIDS <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE pp <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY <br /> [:1 UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑WASTE TrRE <br /> ❑HAZARDOUS WASTE GECNERA70R DAIRY <br /> ❑CHICKEN RANCH El WASTEWATER TREATMENT PLANT <br /> [-]TIERED PERMITTED FACILITY <br /> ❑MOTELIHOTEL ❑PUMPER TRUCI(IYARDICHEMfCALT01l.ETS yy <br /> ❑TATTOOIBODY PIERCING ❑POOL ISPA KLAND USE APPLICATION SITES f <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) 4 X-'Q(p - of <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 MIDST be selected. Fax to(2091464'0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assfstance 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. t <br /> Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425- <br /> EHU-{!SE ONLY <br /> C <br /> E;Hp 48-06 <br /> 6127109 <br />