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FROM : JODI VANNEMAN FAX NO. : 4154793968 �.f Oct. 08 2010 10:47AM P2 <br /> EHD Loc NUMBER <br /> I1 LIl� 0 L/ �D SAN JOAQUIN COUNTY <br /> II�11 11�IIlll��� IJ U �C ENVIRONMENTAL HEALTH DEPARTMENT <br /> UC 0 $ 2010600 East Main St. Stockton, CA 95202.3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.orof <br /> ENPVIRUNIVILNI HEALTH PUBLIC RECORDS RELEASE APPLICATIO�N�j /i �1 <br /> APPLICANT: BUSINESSIAGENCY: (�j u1 cbh_� ` &_l <br /> ADDRESS: !T4^& �'/�L� A Y' CITYISTATE/ZIP:� J <br /> PHONE(tSTIVE 0.3??NTDATE:ONE(2): 3".w5j�4 FACSIMI LE: g03 <br /> TENTA "APINTMP <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List❑Map-Description: <br /> FILEADDRESS EHD USE ONLY <br /> _ Street N Street Name City Unit 1 f� <br /> 4. nit 3 <br /> 7. <br /> 8• ❑Unit 5 <br /> g. <br /> 1D• ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILETS <br /> .'LTNDFRGROIIND TANK(HST)CLEANUP SITE(LOP) Q HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICi.F 5 <br /> OTHER CLEANUP SRE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE ) 71 <br /> �ONOERGROUND TANK(MONiTORWGIREMOYAL)K. ❑DDG KENNEL ❑DAIRY (,UI��Iq � <br /> �t1AIARDOUSWASTE GENERATOR ❑CHICKEN RANCH ASTEWATER TREATMENT PLANT /(r/�",V <br /> �IERED PERMITTED FACILITY ❑MOTELIHOTEL �UMPER TRUCKNAROICHEMICAL TOILETS <br /> []TATTOOIBODY PIERCING ❑POOU/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACII ITY ❑0THE 9(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8'00 AMS:DOPM(EXCLUDING HOLIDAYS) <br /> 1. ,List upfp 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-tor 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 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 END 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$122 deposit prior to review, <br /> eNnuSE orv4r - <br /> tc-I <br /> -I a s ✓' <br /> 0 <br /> ERD. •-- <br /> orrzsno <br />