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ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />DATE RECEIVED <br />r <br />EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />OTHER CLEANUP SITE (NON -LOP) <br />�NDERGROUND TANK (MONITORING/REMOVAL) <br />do& Ark <br />600 East Main Street, Stockton, CA 95202-2708 <br />2008 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: ww.sjgov. r <br />wh <br />OWASTE TIRE <br />❑ DAIRY <br />HAZARDOUS WASTE GENERATOR <br />UBLIC RECORDS RELEASE APPLICATION <br />1:3 WASTEWATER TREATMENT PLANT <br />APPLICANT: 1 <br />ADDRESS:VLLt� <br />(IL <br />1 BUSINESS/AGENCY: <br />e c k -6 -vim. <br />❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />PHONE (1): <br />PHONE (2):I �{G� �' FACSIMILE: TC) I ID Q�XI <br />❑ LAND USE APPLICATION SITES <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - *Tentative only - must be confirmed) <br />❑ OTHER (PLEASE SPECIFY) <br />❑ CHECK BOX TO EXPEDITE R EST - 98. FEE (CASH OR CHECK ONLY) - REQUEST PROCIESSEDY 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE At <br />Electronic Information: <br />❑ List ❑ Map — Description: <br />FILE ADDRESS EHD USE ONLY <br />11WICW1 <br />Street # <br />Street Namer— k4City <br />❑ Unit 1 <br />0 <br />2. <br />��� -, ®�� 1 El Unit 2 <br />l <br />b1p <br />/ <br />3. <br />4 <br />tX/ <br />K6. <br />5. <br />7. <br />$ <br />^Unit 4 <br />�J� U v ' - � D <br />`nn ❑ Unit 5 <br />V <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) <br />❑ HOUSING ABATEMENT <br />❑ ,OLID WASTE FACILITY/VEHICLE <br />OTHER CLEANUP SITE (NON -LOP) <br />�NDERGROUND TANK (MONITORING/REMOVAL) <br />❑ FOOD FACILITY <br />0 DOG KENNEL <br />OWASTE TIRE <br />❑ DAIRY <br />HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />1:3 WASTEWATER TREATMENT PLANT <br />.23'TIERED PERMITTED FACILITY <br />13 MOTEL/HOTEL <br />❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />13 TATTOO/BODY PIERCING <br />❑ POOL/SPA <br />❑ LAND USE APPLICATION SITES <br />MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:OOPM - 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 EHD 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 $98.00 deposit prior to review. <br />EHD USE ONLY <br />*** If you should need further assistance please contact Diane Martinez -@ (209)468-3425 directly. Thank You*** <br />EHD 48-06 9/14/2006 <br />