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U001/001 ' <br /> fF;E RECEIVED "' EHD LOG NUMBER <br /> F�� I SAN .,IOAQUJN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 ' <br /> -L?V 1 :0 2009 Telephone: (209)468-3420 Fax: (209)464-0138 Web:www:sjgov.org t <br /> AL.TF! <br /> ENV!�UPjvlkf'�T HEPUBLIC RECORDS RELEASE APPLICATION . <br /> PERMIIIIIXAPPLICANT: a � L�C4$f( " BUSINESS/AGENCY: r _ <br /> ADDRESS: 00570 CITYISTATE21P:RlQdcho GGfi�ov�l = C ! 95 71 <br /> PHONE(1): 9i Sb� �S'63 PHONE(2 : 1 5-03 r FACSIMILE:9)& (o3 ?a 85 <br /> TENTA TIVE*APPOI NTMENT ATE;, 11 lime. <br /> (Please allow 10 busine / <br /> a s from date <br /> Y p lication u ittai- Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE EST-$115 r (G H R ONLY)-REQUEST PROCESSED IN 3 BU IN PA <br /> yS <br /> SIGNATURE OF APPLICANT DATE /l <br /> Electronic information: ist❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ' <br /> 1. n Unit 1 <br /> IE 14 - NA 5iac a <br /> 2.- <br /> El El Unit 2 <br /> L67. <br /> Unit 3 <br /> �7�j = .; Unit 4 <br /> 8. <br /> 9. Unft 5 <br /> 10. <br /> Specific Date Range of Inform D Unft 6 <br /> g ormation Requested From <br /> 4 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> XUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY <br /> [:1 WASTE TIRE <br /> I4'UNDERGROUNDTANK(MONITORINGfREMOVAL) EJ DOG KENNEL n DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH [jWASTEIyATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL <br /> El TATTOOIBOOY PIERCING ❑PUMPER TRUCKIYARp1CHEMICAL TOILETS <br /> ❑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 AM-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses 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 MIDST be selected. Fax to(2091464-0138 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 /> f 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 expense of the applicant. <br /> Future file reviews by the same applicant may require a-$1 15 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,-at(209)468-3425: <br /> � 1 <br />.i EHU USE ONLY <br /> V _ <br /> I <br /> N .06 <br /> " 8127!89 <br /> Ih� <br />