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LA;I-bb-200`1 12:31 P.02 <br /> M110 <br /> RECCSAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0 6 2009 600 East Main St.Stockton,CA 95202-3029 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:vvww.sjgov.o e <br /> ENVIRUNsotNT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PER ,,�^- ,q. <br /> APPLICANT: BUMNESSIAGENCY: t�5'aA Ire <br /> ADDRESS: p_1(Vfe_ GITY/STATEIZIP: @d7r �- <br /> PHONE(1) !d 7e� , PHONE(2): FACSIMIL r . <br /> �-,,�n T NTATI E'APPOINTMENT DATE: Time: <br /> ?e{A Q" (Please allow t0 business days from date app cat on submittal-''TerrtaNve only-must be conttnned <br /> 101117M �1b,CHECK BOX TO EXPEDITE REQ T-s FE C H CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ®ATE <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS EHO USE ONLY <br /> Store,# Street Name City ❑Unit 1 <br /> F2 . <br /> a �!o <br /> CPP o <br /> . Z <br /> o ! <br /> 4- <br /> 5. <br /> 6. nit 4 <br /> 106-S,No(l .r3 (t <br /> g, ®Unit <br /> 9. <br /> 10. CI Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 00ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIUTYNEHICLE :7_41e� <br /> THER CLEANUP SITE(NON-LOP) ❑F000 FACILITY ❑WASTE TIRE /� L <br /> ERGROUNo TANK(MONiTORINGIREMOVAL) El Dor.KENNEL El DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT �/ <br /> ❑TIERED PERMITTED FACILITY [IMOTEIIHOTEL ❑PUMPER TRUCKIYARDICHEMiCAL TOILETS �Z ffDq <br /> ❑TATTCdBODY PIERCING ❑POOLJSPA ❑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 up to ten addresses 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(2Q2j4j!E0j38 or mail to the addEgo in 'galod 9bovo. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications recelved after <br /> 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant if any EHO files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will behold 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 retumed 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 /> S. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EHe SE ONLY <br /> i 10-ir OC( <br /> ,e <br /> EHD 48-06 Bayo <br /> TOTAL P.02 <br />