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DARMt�IV!IaT�[I. Jf SAN JOAQUIN COUNTY - EHD LOG NUMBER <br /> U � EIS kONMENTAL HEALTH DEPARTMErNT <br /> N -,15 2009 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIR0NIVIENTHE1 Fpone: (209) 468-3420 Fax: (209) 464-0138 Web: wwW.sjgov.orL- . <br /> Mq <br /> P€RMIT;SERM.E PUBLIC RECORDSRELEASEAPPLICATION <br /> APPLICANT: 'SOPS BUSINESSIAGENCY: Yui_ <br /> ADDRESS: CITYISTATE/ZIP: <br /> PHONE (1)- PHONE (2): FACSIMILE. <br /> TENTATIVE'APPOINTMENT DATE: S{L_ Q F 9-13 11 I Time: ? <br /> (Please allow 10 business days from date of application submittal.-Tentative onl r-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITEMQUEST15 00 F (C1A}S�H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANV .�tlnMra DATE ` I <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> � ❑Unit 1 <br /> 2. <br /> 3. <br /> 4. ) <br /> 5. ❑unit 3 <br /> 6. <br /> ❑Unit 4 I� I <br /> 8. <br /> ❑Unit 6 <br /> 9• veri cha4yLr, mo <br /> 10. 1 i lis {p reJi eWed m.'tt- N earth <br /> tl t1o( 0Unit6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> El OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑SOLID WASTE FACILNYNEHICLE <br /> El UNDERGROUND TANK(MONITORINGIREMOVAL) El DOG KENNEL El WASTE TIRE <br /> ❑HAZARDOUS WASTE GENERATOR ❑DAIRY <br /> ❑CHICKEN RANCH ASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY _ ❑MOTELIHOTEL MPUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑ <br /> TATTOO/BODY PIERCING ❑POOL/SPA <br /> ❑ ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY <br /> ❑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 up 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(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 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$115.00 deposit prior to review. <br /> END USE ONLY <br /> ***If you need further assistance please contact Diane Martinez direct) Q (209)468-3425. Thank You*** <br /> cwn Banc <br />