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Fl K I E ,I VLV WE ll 408 260 6627 • Mar. 28 2011 05:40AM PI <br /> DATE RECEIVED EHD LOG NUMBER <br /> 1,11,11V8 2011 SAN .IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT ( <br /> ENVIRONMENTAL HEWT 600 East Main St. Stockton, CA 95202-3029 <br /> PERMIT/SERVICES-phone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 'FY (je, BUSINESSIAGENCY:�Cj( 'n ii <br /> ADDRESS: I3 �� CITY/STATEIZIP: �SrC1 p�I,30, <br /> PHONE(1)7 PHONE(2) FACSIMILEA&000 -202 <br /> TENTATIVE'APPOINTM NT DATE: wy Time: )t'30 Cr Cldo <br /> ,�/ (Please allow 10 business days from data of application submittal-"Tentative only-must be confirmed) <br /> UV CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT &L I,-) EGC ( Q ; DATE �j ( <br /> Electronic Information: NrListEl Map—Description: <br /> -FILE ADDRESS EHD USE ONLY <br /> street Street Name J City 0 Unit 1 <br /> Z El unit 23 <br /> 3. <br /> 4• unit 3 J <br /> 5. i= <br /> 6. unit 4 <br /> 7. <br /> L10, <br /> Unit 5 <br /> unit <br /> Specific Date Range of Information Requested_ From wyl Q as I to (A.It f• <br /> y/ ENVIRONMENTAL HEALTH D P RT T FK_ <br /> ,^�,`` <br /> I^J�''^u•DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSINGABATEMENT I-DI DLID WASTE FACILITYNEHICLE <br /> )v�—�`OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> E4NDERGROUND TANK(MONnoRINGIRENOvAL) ❑DOG KENNEL ❑DAIRY <br /> Lv�H DOUS WASTE GENERATOR El CHICKEN RANCH El WASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑MOTEIIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> O TATTOO/BODY PIERCING ❑POOL/SPA ❑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 AMS:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up tp ten address in the space above. Select 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 ten(10) <br /> days after receipt of application. The flies 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$122 deposit prior to review. <br /> EHD USE ONLY <br />