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NOV-27-2012 06:06 Mar n & Associates 904 674 6316 P.01/01 <br /> � low/IRWMED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> L. V ENVIRONMENTAL HEALTH DEPARTMENT <br /> NOV 27 2012 600 East Main St.Stockton, CA 95202-3029 (`�`1 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd p <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PE iMlTresI i_ <br /> - <br /> APPLICANT: Carol Wheeler BUSINESS/AGENCY: Martin Environmental <br /> ADDRESS: 8823 San Jose Boulevard Suite 103 CITYISTATEIZIP: Jacksonville FL 32217 <br /> PHONE(1): 904-737-1034 PHONE (2): 904-437-2417 FACSIMILE: 904-674-6316 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE RE EST-$115 FEE(CASH OR HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE j/ -s�7- /� <br /> Electronic Information: ❑List❑ Map-Description:. <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1 1153 Vanderbilt Circle Manteca <br /> 2. 1-10o ❑Unit2 1) <br /> 3. <br /> 4. Unit 3 <br /> 5. j 17rS e <br /> 6. 16'ie C131vc_lc �e_l Unit 4 c <br /> T. it <br /> s. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ,ajNDERGROUND TANK.(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> 4®FHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> -TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY p OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 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(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 END will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) _ <br /> days after receipt of application. 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 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 Diane Martinez,at(209)468-3425. <br /> Mo USE ONLY <br /> I <br /> EN❑�9-06 <br /> Received Time Nov, 27. 2012 5: 19AM No. 1695 <br />