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02/05/2010 15: 03 9168610430 STANTEC PAGE 01/01 <br /> nD� llT ❑� V �� SAN JOAQUIN COUNTY EHD L00 NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 0 5 2010 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: vvww.sjgov.orglehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> P <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: CITY/STATEIZIP:��� tOa t' <br /> PHONE (1): - PHONE(2): FACSIMILE: 9X <br /> TENTATIVE*APPOINTMENT DATE: F,ed/Q Time <br /> (Please allow 10 business days from data of app cation submittal-*Yenfative only•must he 0onflrmed) <br /> 0 ❑CHECK BOX TO EXPEDITE REQUE -$116 FEE(CASH OR CHECK ONLY)-REQUEST PROCF-55ED IN 3 BU IN.S5 DAYS <br /> ( SIGNATURE OF APPLICANT r ( `-'- DATE .r�(0 <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILA_ADDRESS EHD USE ONLY <br /> Street# 9trset Name <br /> 11 Clty <br /> t <br /> YYQ� �Ot or) <br /> C2- M ���i26�a fire Stockton T(0 1-3, <br /> 3. <br /> 4 <br /> 5. nit 3 \� <br /> 67. nit a <br /> 8. ❑Units <br /> v,' ❑Unit <br /> Specific Date Range of Information Requested: From � ko r <br /> ENVIRONMENTALLTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTC FACILITYIVF.HICLC <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE n <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)� F]DOG KENNEL [3 DAIRY UA <br /> HAZARDOUS WASTE GCNERATUR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL <br /> ❑TATTOOIBODY PIERCING ❑PUMPER TRUCKIAMICAL TOILETS <br /> ❑P <br /> POOL/SPA LAND USE APPLICATION <br /> 710N SI SITES I V <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 fZQ9)464.0138 Qr ln,ail to the add ess Indlcatsd ove. 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 applicatlon. 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 he 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 appilcant. <br /> Future file reviews by the same applicant may require a$116 deposit prior to review. <br /> S. If you need further assistance,please contact Diane Martinez,at(208)468-3425. <br /> rNb VIE ONLY <br /> Wi yp <br /> EHD 440.06 <br /> 0127108 <br />