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DA �/Jj�� <br /> t�IV/Ir"�[I: fF SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> II�� l/ L^ a� EN'1111`6ZONMENTAL HEALTH DEPARTMENT <br /> by : �d 5 2009 600 East Main St. Stockton, CA 95202-2708 <br /> T hone: (209) 468-3420 Fax: (209)464-0138 Web: WWW.sjgov.or <br /> 4M <br /> yri <br /> ENVIRl1IVMtNTtiE <br /> PERMITISMVI;,'ES PUBLIC RECORDSRELEASEAPPLICATION <br /> APPLICANT: ) BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: <br /> PHONE (1)• Q PHONE (2): FACSIMILE. <br /> TENTATIVE`APPOINTMENT DATE: s[L_ OF 9 r( 3 I 1�gTime: ? <br /> (Please allow 10 business days from date of application submittal-'Tentative onl -must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE�QUEST_$�11600F (CASH OR CHECK ONLY)-REQUEST PROCESSEDIN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN DATE � d <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City - El Unit 1 <br /> 1. <br /> 2. # IOLL , <br /> 3. _ J mt 2 <br /> 4. 1 <br /> ❑Unit 3 <br /> 5. V <br /> 6. <br /> ❑Unit 4 I� I <br /> 7. <br /> N9.o <br /> Car <br /> [I Unit 5 <br /> Ca Gh le. treo es rl les fo Ix fet/i e,)ed m A- N erv14� <br /> i lI l01 ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> [:]OTHER CLEANUP SITE(NON-LOP) El FOOD FACILITY [j SOLID WASTE FACILITYNEHICLE <br /> E]UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑WASTE TIRE <br /> ❑HAZARDOUS WASTE GENERATOR El DAIRY <br /> ❑CHICKEN RANCH ASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY _ ❑MOTELIHOTEL MPUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA <br /> ❑ ❑LAND USE APPLICATION SITESMEDICAL WASTE FACILITY <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8:00 AM-5:OOPM(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) @ (209)468-3425. Thank You*** <br /> FNn axm <br />