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11 / 30 / 2009 111- 54 FAX 1x002 / 002 <br /> � u �D EHD LOCI NUMBER <br /> SAN JOAQUIN COUNTY <br /> NOV 3 4 20p9 ENVIRONMENTAL HEALTH DEPARTMENT ` <br /> y Sao East Main St. Stockton , CA 95202-3dt29 00 <br /> � 1� hone : (209 ) 468-3420 Fax : (209 ) 464-0138 Web : www,sjgov.org <br /> IT SRVITo7 3 <br /> PERS 1 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: PSS BUSINESS/AGENCY: C_ <br /> ADDRESS : 14r ' 1 y6 C* CITY/STATE2IP : <br /> PHONE ( 1 ) : eW6 c> r OC PHONE (2) : (4 k ) Yc(l ^Zg I g FACSIMILE: I4 <br /> TENTATIVE* APPOINTMENT DATE : —UlmT /09 Time: ofbcoo <br /> (Please allow 10 bumneaa days from date of application submittal - ' Tentative only - must be confirmed) �— <br /> [?rCHECK BOX TO EXPEDITE REQ=15 15 F (CA OR CHECK ONLY) - REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN DATE <br /> Electronic Information : ❑ Lis Map — description : <br /> FiLE ADDRESS EHD USE ONLY <br /> Strut # Street Name City J El Vnit 1 <br /> eTtottj <br /> 3 * k�Aggjy JX .':) v/ <br /> 4. W � I l l 4y FD 7kACwYs <br /> 6 . 227YACS <br /> 9 P D 4 <br /> 7 . <br /> 8 . <br /> Unit 5 <br /> 9 . <br /> 10M <br /> ❑ Unit 8 <br /> Spacific Date Range of Information Requested : From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br /> r--�,O{THER CLEANUP SITE (NON•LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br /> �E� u DERGROUND TANK (MONIT4RINGIREMOVAL) ❑ DOG .KENNEL ❑ DAIRY <br /> IAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH C] WASTEWATER TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> © TATTOO/BODY PIERCING ❑ Pi VIJ$PA ❑ 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 ( EXCLUDIN (3 HOLIDAYS) <br /> 1 . List up to ten addressel In the apace above. Select the typo(s) of files from the list above by checking the appropriate <br /> box(es). At least one fie type MV $T be selected. Fax to (2091464-0138 or mail to the address Indlcated �g49yQ. 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 now application may be <br /> submitted when the file Is available . <br /> 4. Any file not returned in the dame condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Futuro 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) 488-3426. <br /> PHO USE ONLY <br /> EHD 48-06 8/27/09 <br />