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� ECEYZID <br /> j <br /> EHD LOG NUMBER <br /> MAR U 2010 SAN JOAQUIN COUNTY <br /> I -, ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRUNf� I NT HEALTH 600 East Main St. Stockton , CA 95202-3029 <br /> PERMIT/SERVICESte ,one : (209) 468-3420 Fax: (209) 464-0138 Web : v✓ww.Sjgov.org/ehd /> <br />- i PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: A4kaw cvC- ¢ BUSINESS/AGENCY: �� nV Ironnentr� <br /> ADDRESS: t -S3,3 p S C, R l� ,,.,)TY/STATE/ZIP: a 7 <br /> PHONE oQPHONE (2): „ ' - FACSIMILE:SIO — 8�} <br /> TENTATIVE' APPOINTMENT DATE: 3 - M — ID Time: <br /> (Please allow 10 business days from date of application subml t Tpef$t�ve only • must be confirmed , • . <br /> CHECK BOX TO EXPEDITE REQUEST - $ 115 F AS OR CHECK ONLY R,E¢111E,�, ,T PROCESSED IN 3 BUSIN�9$ H9 <br /> SIGNATURE OF APPLICANT 1�0 DATE 3 � 10 -1 6 ' <br /> Electronic Information: <br /> List El Map - Description : <br /> FILE ADDRESS _ EHD USE ONLY <br /> #),b <br /> Street Name city _ ❑ Unit 1 <br /> F(`2}r-n0n S f� G t; �C! rs FT' rtQyvT JCr S On 7 ti '--> ❑ Unit 2 r�^� Unit 1 <br /> 54 <br /> 61 <br /> 8 . <br /> 9 ';s r _ _❑ Unit 5 <br /> R^ <br /> L <br /> 10: es <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: Fro trul to _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> R UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT [ISOLID WASTE FACILITYNEHICLE <br /> HER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br /> ,UNDERGROUND TANK (MONITORING/REMOVAL) [71 DOG KENNEL ❑ DAIRY <br /> ,HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ 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:GOPM (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) 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 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 expanse of the applicant. <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 /> EHD USE ONLY <br /> EHD 4e-e6 OnT109 <br />