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UCI—Iib-200y 12:31 <br />F-1 <br />:J <br />FJ <br />M END LOG NUMBER <br />RECEM10 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />01,f 0 6 2009 600 East Main St. Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.o#e7 <br />�NVIRU►�(tNT HEATH PUBLIC RECORDS RELEASEAPPLICATION <br />APPLICANT: <br />ADDRESS: , N' t / <br />PHONE (1):�)!d7� 7 PHONE <br />NTA TWE* APPOINTMENT DATE; <br />(Please allow 10 business days from date <br />10101 —)OXCHECK BOX TO EXPEDITE"REQ T - S FEE <br />SIGNATURE OF APPLICANT , <br />BUSINESS/AGENCY: 4 l re— <br />CITY►STATEMP:Ao ,(JA�,&-7',�.LY* <br />• FACSIMIL�' <br />Time: <br />on submittal - "Tentsovs only - must be confirmed <br />CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />DATE /O 1d ! &--I — <br />I Electronic Information: ❑ List ❑ Map — Description: _ 1 <br />Specific Data Range of Information Requested: From <br />_ to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />[� ERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITYNEHICLE <br />THER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ WASTE TIRE <br />ERGROUND TANK (MONITORNGIREMOVAL) <br />❑ DOG KENNEL <br />❑ DAIRY <br />AIARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT <br />Q TIERED PE:RMMED FACILITY <br />❑ MOTEIIHOTEL <br />❑ PUMPER TRUCKNARD/CHEMICAL <br />❑ TATTO01BODY PIERCNG <br />❑ POOUSPA <br />❑ LAND USE APPLICATION SrMS <br />❑ MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />111 <br />:7-kk4r <br />Wdrf� <br />y�Q' <br />TOILETS <br />WELT. AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FPjDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />1. Llst ua to 1pa 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 13 r mail to g adftss in ' ov . 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 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 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 END 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 Martinet, at (209) 468-3425. <br />TOTAL P.02 <br />