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9. 20i(0 11 : 20A,V! R noon Consultants, Inc. — k 7000 P. 1 <br /> R RE RRI <br /> 1-� SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIR'�(.wlii1= � i' lEA hone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.or <br /> PERMITSERVICL PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_LVv L� BUSINESS/AGENCY; <br /> ADDRESS: �(0 �SS CITY/STATE/ZIP: l�etrl <br /> PHONE 1 : (Dy( 1 moa "Y}PHONE(2): — - I C-/t- <br /> ( ) FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: <br /> (Please allow 10 business days from date of appllcation submittal- TTentative only-must be confirmed) <br /> ❑CHECK BUX TO EXPEDITE RE EST-$115F (CASH OR CHECK ONLY)-REQUE$T PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT p <br /> DATE <br /> Electronic Information: ❑ List Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street R Street Name <br /> 1. 7 City Unit 7 <br /> Udo <br /> It 2 <br /> 4- <br /> A <br /> 5 r ' <br /> nit 3 <br /> 000 <br /> 7. 4' , <br /> 9• ❑Unit 5 <br /> 10. <br /> Specific Date Range of Information Requested: From ❑Unit 6 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES to <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOU5ING ABATEMENT <br /> 9NDERGROVND <br /> THER CLEANUP SITE(NON-LOP) El FOOD FACILITY ❑50L10 WASTE FACILITYNEHICLE <br /> TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑WASTE TIRE <br /> HAZARDOUS WASTE GENERATOR ❑DAIRY <br /> El TIERED PERMITTED FACILITY Q CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> E]TATTOOIBODY PIERCING ❑MOTELIHOTEL PUMPER TRUCK/1'ARDICHEMICAL TOILETS <br /> ❑ MEDICAL WASTE FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITE$ <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM(EXCLUDING HOLIDAYS) <br /> 1. List u L10 ten addressea In the space above. Select the type(s)of files from the list above by checkin the a <br /> box(es). At least one file type MUST be selected. Fax to 209 464-)138 or mall to th address indropria <br /> icated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applicatio <br /> 3:00 pm will be processed the next business day. is received after <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 expense of the appllcant. <br /> Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> S. If you need further assistance,please contact Diane Martinez,at(209)463.3425. <br /> EHD U3E ONLY <br /> EHD 48.06 <br /> 8127/09 <br />