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M * s; 4i��rrl �� SAN JOAQUIN COUNTY z ,l'- <br /> D P IL l <br /> !' X/ I L- <br /> =�1',�` `' `1 �� ENS' yONMENTAL HEALTH-DEPAeRT�,'r�4 <br /> Lli II� 6East Main St. Stockton, CA 95204 <br /> e�le�hone: (209) 468-3420 Fax: (209) 464-0138 We v+r.SigOv.orglelid <br /> , <br /> 5r APPLICATION <br /> F���!ST;;;�R,.�i�:45 PUBLIC RECORDS RELEASE <br /> APPLICANT: •7-'`-e- C) BUSINESSIAGENCY: <br /> ADDRESS: 1 h S{e2�IJ CITYISTATElZIP: <br /> PHONE(1): CJ Q- PHONE FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: V y"a Z <br /> 2010 Time: A <br /> (Please allow 10 business days from date of app ca ion sub i- Tentadv+e only-must be confirmed) <br /> HECK BOX TO EXPEDITE REQWEPT-$115 SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUST ESS DAYS <br /> SIGNATURE OF APPLICA DATE <br /> F Electronic Information: VqL1StaMap- scriptfon: rb �'�"�'�i � ✓l 1�3C <br /> FILE ADDRESEHD USE ONLY' <br /> street# Street Name City _ ❑Unit 1 <br /> 2. — L (� �� �� Q Unit 2 <br /> p <br /> r .. <br /> 4• i Unit 3 <br /> 5. <br /> 6. 2_2-3 �Gt ��►� c jnt <br /> 8. 102:4 , ��o n e d 10. <br /> Specific Date Range of Information Requested: From [k 7 7 to <br /> -ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 19fUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT r99S0LID WASTE FACIUTYNEHICLE <br /> bo OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> NDERGROUND TANK(MONITORINGJREMOvAL) ❑DOG KENNEL ❑DAIRY <br /> A7ARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> fERED PERMITTED FACILITY ❑MOTELIHOTEL <br /> ❑TATTOOBODY PIERCING � El PUMPER TRUCiCIYARDICf{EMICAL TOILETS <br /> ❑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-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List un to-ten addresses in the space above. Select the type(s)of files from the fist above b checking the appropriate <br /> box(es). At least one file Y ee. d <br /> type MUST be selected. Fax (209}4640138 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 expense 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 /> END USE ONLY <br /> EHD 48-08 <br /> - 8!27!09 <br />