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SAN JOAQUIN COUNTY � � kHD LOG NUMBER <br /> ENEw&NMENTAL HEALTH DEPARTMt iT <br /> FEB 0 9 2010 600 East Main St. Stockton, CA 95202-2708 <br /> T hone: (209) 468-3420 Fax: (209) 464-0338 Web: www.s ov.arg hd <br /> ENVIRONNIA�r HEAg�l� i ;9 <br /> PERMIT SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: . €` <br /> BUSINESSIAGENCY: � <br /> i ADDRESS: <br />� � c� i �` CITYISTATEIZIP: <br />� PHONE :1 2b <br /> ( I ? 7 PHONE (2): i FACSIMILE:�6j ` <br /> TENTATIVE*APPOINTMENT DATE: <br /> 'i Tme: <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 /> I SIGNATURE OF APPLICANT DATE Z <br /> Electronic Information: El List❑tap—Description: F I <br /> FILE ADDRESS ;i EHD USE ONLY <br /> Street# Street Name City I <br /> ❑Unit 1 <br /> 2. <br /> Unit 2 <br /> 3.4 <br /> Unit 3 <br /> '' ;i f <br /> 6. <br /> 4 <br /> 7. nit 4 <br /> I <br /> 9 j' ❑Unit 5 <br /> � s <br /> 10. <br /> Zit6 <br /> Specific Date Range of Information Requested: From '" to �"1? — <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES�—,/ <br /> E36NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING LJ ABATEMENT JOLID WASTE FACILITYIVEHICLE <br /> ❑OTHER CLEANUP SITE(NON•LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> �"GNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL j [j DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH P`IVASTEWATER TREATMENT PLANT <br /> k TIERED PERMITTED FACILITY ❑MOTELIHOTEL 3 ❑PUMPER T RUCKIYARDICHEMICAL TOILETS <br /> l ❑TATTOOIBODY PIERCING ❑POOLISPA. <br /> ❑ MEDICAL WASTE FACILITYElLAND USE APPLICATION SITES <br /> ❑OTHER(PLEASE SPECIFY) t <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List u to ten addresses ' <br />'E A s �n the space above. Select elect the types)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 <br /> days after receipt of application. The files will be held for a maximum of five business days for review. App ntments (10) <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHL]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 /> - EHD USE ONLY EF <br /> ***Ifyou need further assistance please contact Diane Martinez direct! e (209)468-3425. Thank You*** <br /> Fwn AA-.F <br /> Ion �nnn <br />