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SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> EN,..kONMENTAL HEALTH DEPARTMt:NT <br /> FEB 0 9 2010 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIRONMENT 419hone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org hd <br /> 6 q0 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: "C�i'Z !�fl yi`\(� a'7 BUSINESS/AGENCY:_ <br /> ADDRESS: W44411111.A . F CITY/STATE/ZIP: <br /> PHONE (1): -7 PHONE (2): FACSIMILE: Lk7 —()(X)7 <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 REQUEST-$115.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESSDAYS <br /> SIGNATURE OF APPLICANT S DATE Zlei �16 <br /> ( Electronic Information: ❑ List ❑illap—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> \ Street# _ Street Name City <br /> I. 7 }L � dt (:^ r u O Z )I C�l✓5/(fJJ <br /> 2. 2� U NIL . e:— `�2X_ ��( U `r OZ ( � OCs. Unit 2 <br /> 3. <br /> 4. <br /> -- -- - - Unitt- <br /> 6. <br /> 7. <br /> E] Unit 5 <br /> 9. — - - <br /> 10. <br /> unit 6 <br /> Specific Date Range of Information Requested: From l to <br /> ENVIRONMENTAL H AL H DEPARTMENTFILES ' <br /> [3'GNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT Q SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ®'GNDERGROUND TANK(MONITORINGIREMOVAL)V\ ❑DOG KENNEL ❑DAIRY <br /> jAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH �'✓�/��/�� <br /> TIERED PERMITTED FACILfT MOTEL/HOTEL �GVASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED <br /> PIERCING � ❑ ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑POOL/SPA ❑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: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 <br /> .rrequire a $11.5.00 deposit prior to review. <br /> !� rDMa� ONLY <br /> ***If you need further assistance le a contact Diane Martinez directly C� (209)468-3425. Thank You*** <br /> - Ila-I _'0 : p, �U P <br /> can ea.na <br /> M IA)I I U /Uri t <br />