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Z001/001 <br /> DATE RECEIVED <br /> U �����% DEHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> VIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> rw V 1 0 2009 Telephone: (209)468-3420 Fax: (209) 464-0138 Web: WwW.sjgov.org <br /> V PUBLIC RECORDS RELEASE APPLICATION <br /> ENVIRU!1MtNTHEALTfi <br /> PERM i 1't� <br /> APPLICANT: (7 k_ BUSINESS/AGENCY: <br /> ADDRESS: /)C) !5,0 W LrC_ p 0cr <br /> PHONE(1): 5-0— -0S-03_ li — CITYISTATE/ZIP:kAwe,,,,,p CQ§JIOVA C6 'JL�'&-7j <br /> ""ONE(2 , —1, FAC <br /> �EN TE' <br /> from <br /> date <br /> PHONE(2 L 5_03, fL&�j FACSIMILE:,9)62 &sa <br /> TENTAT/VE*APPOINTMEN ATE: <br /> s e <br /> (Please allow 10 by Time: <br /> ittai-*Tentafive only-must be confirmed) <br /> busine ays from date p Ii ation u /o <br /> _T <br /> CHECK BOX TO EXPEDITE EST-$115 F H ONLY)-REQUEST PROCESSED IN 3 BU INE DAYS <br /> 4 1/ <br /> SIGNATURE OFAPPLICANT <br /> DATE <br /> LElectronic Information: EXist 0 Map—Description: <br /> —7 FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> iti <br /> A <br /> A <br /> Al <br /> F2 _ <br /> 3. L3 Unit 2 <br /> 4. <br /> hit 1, <br /> 6- <br /> [7 Unit 4 <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From ❑Unit 6 <br /> ENVIRONMENTAL HEALTH—DEPARTMENT FILES to <br /> XUNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT <br /> ❑OTHER CLEANUP SITE(NON-LOP) EIFOOD FACILITY [I WASTE TIRE 0 SOLID WASTE FACILITYNEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVALC�' ❑ <br /> 0 DOG KENNEL <br /> 1-1 D <br /> El HAZARDOUS WASTE GENERATOR El jP <br /> CHICKEN RANCH AIRY <br /> ❑TIERED PERMITTED FACILITY [:]MOTEL/HOTEL 0 WASTEWATER TREATMENT PLANT <br /> El TATTOO/BODY PIERCING 0 POOLISPA F-1 PUMPER TRUCKIYARD/C4iEMICAL TOILETS <br /> [:1 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) El LAND USE APPLICATION SITES <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 <br /> 1. �St�Uto�tenadd�resses In the space above. Select the type(s)of !AM__5001`m(EXCLUDING HOLIDAYS) <br /> box(es). At least one file type MUST be selected flies from the list above by checking the appropriate <br /> . Fax to(2019 464-0138 or mail to the addrm.indicat 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$115 deposit prior to review. <br /> S. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> C.O USE ON <br /> .- <br /> 0 d <br /> EHD 48-06 <br /> 8/27/09 <br />