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Mar 03 2010 1 : 42PM THE UPS STORE #2503 9167?51772 p . l <br /> A —E�Vi±-PI;, I^j 1 -_�. EHD LOG NUMBER <br /> 9 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Maln St. Stockton, CA 95202.3029 <br /> ,1 y e�aphone: (209) 468-3420 Fax: (209) 4640138 Web: www.sjgov.orglehd <br /> VI� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY:Si, <br /> ADDRESS: ^'LO1-u�� �l CITYISTATErZIP:C'c i,--" <br /> PHONE(1): 3660 PHONE (2): FACSIMILE:_ /,3 208 <br /> TFN7ATIIVIE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date or application submittal-'Tent Wve onty-must be confinned) <br /> ❑CHECK BOX TO EXPEDITE REQUE -S1 i5,FEE(CASO OF CHECK ONLY)-REQUEST PROCE39ED IN 3 717S DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic InforTnation: ❑ List❑Map— Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 9trost 8 8tro+t Name city171 Unit 1 <br /> a. Unit 2 <br /> 3. d <br /> -- t <br /> 4• /UnIt4 <br /> 6. s� �1Gci <br /> 7. <br /> 8. �Unft 8 <br /> L1110' <br /> i <br /> /Unit A <br /> Specific Data Range of Irifonnatlan Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUNDTANK(UST)CLEANUP SITE(LOP) ❑HOUSNOABATEMENT �SoLIOWASTEFACErNiVEHICLE <br /> LM OTHER CLEANUP SITE(NON-LDP) ❑FooD FACILITY WASTE TIRE <br /> NDERGROUNO TANTS(MC7NITORINWREMOVAL) ❑DCG KENNEL ©DAIRY <br /> AZARDOUB WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL(HOTEL ❑PUMPER TRUCK/YARDICHEMICALTOILET& <br /> ❑TATT0D1800YPIERCING ❑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-6:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List uta to ten addressee In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(201464-0138 or moll to the addrg$g Indicated*bove Address <br /> ranges will not be accepted-for additlonal assistance with file addresses, contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHO will no ty the applicant If any EHD fl lee exist. An appointment for review will be corTfirmed approximately ten (10) <br /> darn attar recei t of application. The tiles will be held for a maximum of five business days for review. Appolnttienta <br /> should be ache tiled accordingly. <br /> 3. A fl le that b raft ly being worked on by EHD staff may not be lmmedlebely avallable for review. A new application may be <br /> submitted when the file Is available. <br /> 4, Any file not retu ned In the same condition as releeeed will be reorganized by EHD staff at the expenet of the applicant <br /> Future file revie by the same applicant may require a$115 deposit prlor to review. <br /> 5. If you need fu or assistance,please contact Diane Martinez,at(209)4684426. <br /> !HD AF ONLY <br /> EM D 40.00 <br /> iJY7109 <br />