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FROM : .JODI VANNEMAN FAX NO. 4154793988 Oct. oe 2010 10:47AM, P2 <br /> EMU LOG NUN155#, <br /> SAN JoAousN COUNTY P <br /> V U ENVIRONMENTAL HEALTH DEPARTMENT !� <br /> U r Q O 1 600 E=ast Maid St. Stockton, CA 95202-3029 <br /> Telephone, (209) 41x8-3420 Fax: (209) 464-013B Web: www_si9oV.or eh <br /> F77 <br /> ENVIRUNIVIE I HEALTH PUBLIC RECORDS RELEASE APPLICATION i <br /> P <br /> APPLICANT_ BUSI111ESSIAGI=NCY:� <br /> ADDRESS: ����� 1'_-�� a ... _ CITYISTATElZ1P: h <br /> PHONE(t):Lh9• FiONE(7): N 14 FACSIMILE: <br /> TENTATIVEkAPP INTM NT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tontative Only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-S122 FEE(CASE{OR CHECK ONLY),REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ __ DATE <br /> Electronic Information: ❑List❑Map—DeSCription: <br /> FILE ADDRESS EHD USE ONLY <br /> - <br /> Street# - Street Name City ' — Unit 1 <br /> 1. <br /> 2' --�_ nit 2 <br /> 4_ nit 3 I <br /> i <br /> 5- <br /> W,W__, <br /> ::- <br /> 7. <br /> E]Unit(I <br /> Specific Date Range of Information Requested- From to _ rl <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> .. OMI)FRGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT -]SOLID WASTE FACILITYNEHIGLF <br /> ;JeDTHE:R CLEANUP SITE(ION-LOP) ❑FOOD FAGLITY } WASTE TIRE <br /> �+ UNDERGROUND TANK(MONITORiNCJREMOVAL) ❑DOG KENNEL [j DAIRY <br /> ;rMAIARDOUS WASTE GENERATOR ❑CHICKEN RANCHASTEWATERTREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTFOHOTEL �UMPER TRUCKNARDICHEMICAL TOiI_ETS <br /> ❑TATTOOIBODY PIERCING E]POOIJSPA LAND USE APPLICATION SITFS <br /> Ej MEDICAL WASTE.FACII,ITY ❑OTHf R(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE POR Rpyi w., MonnAY--FRIDAY 8.00 Am-5:01PM IZExCLUDING HOLIDAYS) <br /> 1, 9st u to ad resses in the space above, Select the type(s)of tiles from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. rax to(209)454 0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2_ The EHI)will notify the applioaht if any EHD Tiles exist An appointment for review will be confirmed approximately ten (10) <br /> days after receipt of application_ The files will ba 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 EHO staff may not be Immediately available for review. A new application may he <br /> SUbMitted when the Tile is available, <br /> 4. Any t1e not returned in the same condition as released will be reorganized by EHO staff at the expense of the applicant. <br /> Futurefile reviews by the Same applicant may require a$122 deposit prior to review. <br /> �Nq u8E a��r <br /> EFID a9-os . <br /> 07!29!7 0 <br /> E <br />