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Mar 03 2010 1 : 42PM THE UPS STORE 42503 916751772 <br /> F . 1 <br /> FDA I8 1 II �) EHD LOG NUMBER <br /> rrf I I ,l ( I JI <br /> . i—',i �I J —I r SAN JOAQUIN GOUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT (� <br /> L0 600 East Main St. Stockton, CA 95202-3028 t <br /> 9� Phone: (209) 48&3420 Fax: (209) 464 �Aww.sigov.org./ehd, <br /> Web: w ,sjgov.orglehd <br /> ¢sc. a'Ll <br /> -1 <br /> p F P rfi ;; C)i" r,j_, PUBLIC <br /> /RECORDS RELEASE APPLICATION <br /> APPLICANT: I ( N'1L BUSINESS/AGENCY:-JI,"i ��r � <br /> ADDRESS; ['e+l',` fQ. MU6 ��. �/ CITYISTATEIZIP:<,_1c,7�- / <br /> PHONE(1): 9,11 3 fr7 06161GEPHON (2): FACSIMILE: 20$ <br /> TEh7A71,VE'APPOINTMENT DATE: Time: <br /> (P Lse allow 10 buslne*s days from date of aippllcstlon submittal-'Tentedve only-musrt be oonfinned) <br /> ❑CHECK 13OX TO EXPEDITE REQUF -S1 i/5p,FEE(CAS 0 CH K ONLY )-REQUEST PROCE89ED IN 3 BYGINE08 DAYS <br /> SIGNATURE O APPLICANT DATE / <br /> ej <br /> Electronic Inform tion: ❑ Llst❑Map- D"criptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> Street I Street Name city <br /> —__- 171 Unit1 , <br /> 2. <br /> 9, o �e" by- <br /> 4. i—T'9 — Unit3 <br /> 8. <br /> Unit4 <br /> 8. <br /> -- ❑Unita <br /> 9. <br /> 110, <br /> /Unit 9 <br /> 8pectflc Darts Range Irrforrratlan Roqusetod: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TAN (UST)CLEANUP SITE(LOP) ❑HOU81N3 ABATEMENT $OLIO WASTE FACLrrYNEHICLE <br /> 9A2ARDOUS <br /> THERCLEANUPSIT (NON-LDP) LJFOOD FACILITYWASTE TIRE <br /> NDERGROUND TANK(MONITORINWREMOVAL) ❑Ma KENNEL ❑DAIRY <br /> WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELfHOTEL ❑PUMPER TRUCK/YARDICHEMICALTOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOUSPA <br /> ❑ MEDICAL WASTE FACILITY ❑LAND USE APPLICATION SITES <br /> II ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC'PERMI7 RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the typo(%)of files from the list above by checidng the appropriate <br /> box(es). At least one file type MUST be selected, Fac to(209)464-0138 or mail to the addry** Indicated above Address <br /> ranges will not 6e accepted-for additional assistance with file addresses,contact the EHD. Appilcatlons received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD IA1I1 notify the applicant If any EHD I'll"exist. An appointment for review will be corrflrmW approximately ten (10) <br /> day3 afber receipt of application. The file*will be held for a maximum of ftve buol nes%days for review. Appointments <br /> should be pche Liled accordingly. <br /> 9, A fl le thatb act ly being worked on by EHD staff may not be Immedlabely available for review. A new application may be <br /> submitted when the fife Is available. <br /> 4. Any file not rete nod In the some condition ae releaeed will be reorganized by EHD staff at the expense of the appllcant- <br /> Future fife revie by the same applicant may require a$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martlnoz,at(209)468-3426. <br /> PHD 09F ONLY <br /> END 46.06 <br /> •117109 <br />