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n4t <br /> FRE _jPH f3 . KIEy}§ 4a8 260 8627 Mar. 28 2011 a5:40gM P1 <br /> DATE RECEIVED V 1.61 SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> 10 8 1011 ENVIRONMENTAL. HEALTH DEPARTMENT { <br /> ENVIRONMENTAL HE600 East Main St. Stockton, CA 95202-3029 <br /> PERMIT/SERVICES` iphone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ke, BUSINESSIAGENCY:��j <br /> ADDRESS: e CITY/STATE/ZIP: gS)10 <br /> PHONE (1); �OMO_- IqZ ___ PHONE{2) FACSIMILEa �aloo -&Zj <br /> TENTATIVE'APPOINTM NT DATE: F�'l Time: I 150 or C1pO <br /> (Please allow 10 business days from data of application submittal-'Tentative only•must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASHOR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT a h ;✓ fjoj6 /,,fit&I f_) _ DA TE <br /> Electronic Information: P'List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street At Street Name City Ej Unit 1 <br /> 2• ❑ unit 2 .� <br /> 3. I — <br /> 4• Un t 3 <br /> AD <br /> 6. 71 unit a <br /> 7 <br /> S. Unit 5 <br /> 9. <br /> 10. unit s <br /> Specific Date Range of Information Requested: From to fA i '11•- <br /> ENVIRONMENTAL HEALTH DEPARTMENT F ,��,,`` <br /> �DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT LyyOLID WASTE FACILUTIVEHICLE <br /> [^^0`` HER CLEANUP SITE(NON-LOP) 0r-�FOOD FACILITY ❑WASTE TIRE <br /> �ryuNDERGROUND TANK(MONnORINUREMOVAL) LJ DOG KENNEL ❑DAIRY <br /> Uv��DOUS WASTE GENERATOR 0r�7 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 2 TIERED PERMITTED FACILITY n MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> Q TATTOOIBODY PIERCING ❑P00II811A ❑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 AM-S:OOPm(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)484.0138 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 FHD 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 USB ONLY <br />