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EHD LOG NJIMBER <br /> E SAN JOAQUIN COUNTY <br /> 2010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Maln St. Stockton, CA 95202-3029 <br /> EwwwwoENT HEALTp)ephone. (209)468-3420 Fax: (209)464-0138 Web: www-sjgov.orgehd <br /> E 1ITFSERVICES <br /> /► PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:Cbty a ;„ti. _ BUSINESSIAGENCY., S ,-acs <br /> ADDRESS: 3?. r.:A,� �'�U CITYISTATEIZIP; CA <br /> PHONE(1): PHONE(2): FACSIMILE: 116 40•b to <br /> TENTATIVE'APPOINTMENT DATE: l4 t/tt7_ Time:lwot(_ 1'L 00kr. <br /> (Please allow 10 businest days from dateo p licadon submittal-'Tentative only.must bo confirmed) <br /> I <br /> ❑CHECK BOX TO EXPEDITE RE EST-$115 FrEE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Etactronic information: ❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name city unit 1 <br /> 1. Ave- d4 ,.- <br /> 2 ��` c` _ 0 Unit 2 <br /> 3. 4 S:5!5 ' e. <br /> 4 7upeeCkk- J� tel. nit 3 <br /> 8. ---- — nit4 <br /> 7. <br /> 8• ©U nit 5 <br /> 0. <br /> 9 . <br /> Units <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HE=ALTH DEPARTMENT FILES <br /> ;� WNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ER CLEANUP SrrE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNGE:RGROUNnTANK(MOWORINC)REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> Ig HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FActi-my ❑MOTELMOTEL Q PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOAODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILfrY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERM17 RECORDS ARE AVAILABLE FOR REVIEW:•MomDAY-FRiDAY 8.00 AM-5:00PM(EXCLUDING HOUDAYS <br /> 1. List up to ten Eigr01ses In the space above. Seiect the typo(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 12061464-0138 or mall 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 nett 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 atter receipt of application. The files will behold for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. ry. <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 13 lane Martinez,at(206)468-3425. <br /> Ekp USE ONLY <br /> I <br /> EHD 48-08 <br /> al27/p8 <br /> 100/100r8 XVj Loi60 010Z/9Z/60 <br />