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------------------ <br /> DATE RECEIVED EMD LOG NUMBER <br /> JLN j 0 2010 SAN JOAQUIN COUNTY <br /> ���� ( ENVIRONMENTAL HEALTH DEPARTMENT <br /> HEALTH 600 Fast Main St, Stockton, CA 95202-3029 <br /> `P-A i°PERMIT/SERjC Whone: (209)468-3420 Fax: (209)464-0138 Web: vwvw.sjgay.or lti <br /> 4eacro ai �"*6'BLIC RECORDS RELEASE APPLICATION <br /> APPI-ICANT: <br /> - l3iJSINESSIAGENCY: <br /> ADDRESS: `'�t{ Q Siw f. . CITYISTATr/ZIPa <br /> PHONE( ): T— GcQO PHONE 2) :xK <br /> ����gbYF'AGSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time:— <br /> (Please allow 10 btlslness days from date of appllcatlo submittal-*Tentative only-must be conf(rmed) <br /> 0 CHECK BOXTD EXPEDITE REQUI;$ =FEEECK ONLY)-REQUEST PROCESSED IN 3 SUSINE$$DAYS <br /> SIGNATURE OF APPLICANTlj DATE_'_70r�. UQ010 <br /> Electronic Information: ❑List❑Map—Description. <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> �} ri unit I <br /> 2. 3: J fir <br /> Unit <br /> 3. <br /> Unit 8 �a <br /> a007 Kain,, ep di op <br /> 91) <br /> nita <br /> a. <br /> 9. <br /> Unit 5 <br /> ❑Unit 6 <br /> Specific bate Renge of Information Requested: From C to <br /> ENVIRONMr=NTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(US)}CLEANUP SITE(LOP) El HOUSING ABATEMEW ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON•LOp) ❑F000 FACILITY ❑WASTE TIRE <br /> [�UNDERGROUND TANK(MONITORINGIREMOVAL) [E t]OG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH Q WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOYEL <br /> - ©PUMPER TRUCKIYARD/CHEI41rCAL TOILETS <br /> ElTATTOO/BODY PIERCING ❑POOIJSPA <br /> ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE;AVAILABLE FOR REVIEW, MONDAY-FRIDAY 8'00 AMZ'001PM(EXCLUDING HOLIDAY$) <br /> 1. List up jo ten addr�§ses 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. F x to 209 464-0138 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 l~HD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of applicatlon. 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 coindition 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 /> s»o use oH�r <br /> etto as-0s <br /> 8l�7 88 <br /> Z0/Z0 3SVd DNI _1VH1N3S08 63GJ3S b06t'8G69TG IT:tit" OTOZ/01/90 <br />