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npr 27 2010 2: 22PI IRn 51 -4209170 <br /> p. l <br /> DATE RECEIVED Ea iD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehdi <br /> UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSlAGENCY: C IL <br /> ADDRESS: CITY/STATEIZIP: <br /> PHONE (1): (� PHONE (2 : FACSIMILE: 0 o <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 4 business days from date of ppl ion submittal."Tentative only-must be confirmed); <br /> ❑CHECK BOX TO EXPE FTE REQ 5T- 115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 I3SUL2SS DAYS <br /> SIGNATURE OF APPLIC NT DATE . <br /> Electronic information: n List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ON <br /> Street# Street Name City Unit 1 <br /> 1. 1210 erc�K42 5. -- <br /> L I� <br /> 2. �_ <br /> Unit 2 <br /> 3. <br /> N 7 ?Ur <br /> nit 3 <br /> 5. <br /> 6. PE.RRAITI�`tV10ES <br /> nit 4 <br /> 7. lr1 <br /> 8. <br /> ---- - -- - - ❑Unit 5 <br /> 9. <br /> Unit li <br /> Specific Date Range of Information Requested: From A _ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tTATToo/BoDy <br /> ERGROUNO TANK(UST)CLEAN P SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FAD(TYIVEHICLE <br /> ER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> ERGROUND TANK(MONITORIN EMOVAL)� ❑DOG KENNEL ❑DAIRY <br /> �f, . g <br /> ARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TRE4_-MENT PLANT C 1 <br /> ED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRVCK/YA hICHEMICAL TOILETS/ /( <br /> PIERCING ❑POOLISPA <br /> ❑ MEDICAL WASTE FACILITY OTHER <br /> USE APPLICpLJON SITES <br /> ❑OTHER(PLEASE SPECIFY) - <br /> WELLAND SEPTIC PERMIT REC RDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY B:DO AM-S:OOPM(EXCL[J!ING HOLIDAYS) <br /> 1. List uo to ten addresses in t e space above. Select the typo(s)of files from the list above by checking the;appropriate <br /> box(es). At least one file typ MUST be selected. Fax to(209)4640138 or mail to the address indicated al}ove Address <br /> ranges will not be accepted for additional assistance with file addresses, contact the EHD. Applications Oceiyed after <br /> 3:00 pm will be processed th next business day. <br /> 2. The EHD will notify the appli ant if any EHD files exist. An appointment for review will be confirmed appr0�,imately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Apjointments <br /> should be scheduled accordi gly. <br /> 3. A file that is actively being w rked an by EHD staff may not be immediately available for review. A new apjlication may be <br /> submitted when the file is av liable. <br /> 4. Any file not returned in the s me condition as released will be reorganized by EHD staff at the expense of ie applicant. <br /> Future file reviews by the sa a applicant may require a$115 deposit prior to review. <br /> 5. If you need further assistanc ,please contact Diane Martinez,at(209)468-3425. <br /> _ END USE ONLY <br /> 10 LA 6 6 0 A Ac C <br /> Cts 010 d— . <br /> L S 0 / <br /> (F'yV'--r u) <br /> —OH-648-06 1 ( i o <br /> 8/27109 <br />