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Nov 12 2009 5: 13PM HP LASERJET FAX P. 1 <br /> p� <br /> EHD LOG NUMB <br /> JER <br /> DATE RECEIVED SAN OAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton,CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.or <br /> PUBLIC RECORDS RELEASE APPLICATION=21b—.(�LOP APPLICANT: rCI�J� �116 BUSINESSIAGENCY:��ADDRESS: J� V� �� C CITYtSTAIEiZIP:�PHONE(1):C1� 1 ��::j PHONE(2): FACSIMI , <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 RTS - 115 F 5H O HE ONLY)-REQUEST PROCESSED IN 3 BUSINESS.DAY <br /> SIGNATURE OF APPLICANT U DATE 'l <br /> Electronic Information: ❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Stmt s Street Narrre City El Unit 1 <br /> n U ; ° <br /> 2. ❑U <br /> 3. <br /> 4. <br /> rig z <br /> 6. <br /> 6. nit4 <br /> 7. <br /> e ❑Unit 5 <br /> 9. <br /> 10. ©Units <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES I t F" <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE i t <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE S 'y�, <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)x ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑PLIMPE R TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uo 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 1208)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 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 /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EHD USE ONLY <br /> EHD 48.08 8!27/09 <br />