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r Ii EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> DEC 0 9 2008 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIRONMENT HEALTNTelephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/elt <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: W'l,'_ <br /> 7�4 15 BUSINESSIAGENCY: <br /> ADDRESS: �� f CITY/STATE/ZIP ` l�Z-t 2- <br /> PHONE(1): 1-0 (901- 4Y57, PHONE(2); FACSIMILE: <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 ST-$105.00 EE(CAS OR CHECK ONLY -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT el a DATE Z 0 <br /> Electronic Information: ❑ List❑ Map-Description: I <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name <br /> City ❑ Unit i <br /> I I <br /> F-77 <br /> . LN 100 IN J (0- rte. -i ❑ Unit 2 <br /> f <br /> 3. <br /> 4, nit 3 <br /> 6. it 4 <br /> 41 <br /> 7. <br /> S. El unit 5 <br /> 9. <br /> E ❑ Unit6 <br />� 10. <br /> Specific Date Range of Information Requested: From t '. to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 2 I NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT E3 SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE. <br /> 2rUNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑!DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 11WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELMOTEL. 0.PUMPER TRUCKIYARDICHEM TOILETS <br /> I ❑TATTOWBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW - MONDAY-FRIDAY 8:00 ANI-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 /> l 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 atter <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 receiptrof 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$105.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br />