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DtlInT La'l SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTA DEPARTMENT <br />DEC 0 9 2008 600 East Main St. Stockton, CA 95202-2708 <br />ENVIRONMENT HEALTHTele- phone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/eh <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />EHD LOG NUMBER <br />qgqb <br />APPLICANT: rz/V- .tO 55 -L4,P-.; <br />ADDRESS: Ti V•a- ‘(2.5' CITY/STATE/ZIP 56,14440-2,, e'eq- <br />PHONE (1): )---0 6? 0 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 />El CHECK BOX TO EXPEDITE RE ST - $105.00EE (CAS OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE ( 2--/97 0 <br />I Electronic Information: LII List Map — Description: <br />I <br />FILE ADDRESS EHD US = ONLY <br />Street # Street Name City <br />‘ <br />Unit 1 <br />Unit 2 <br />• <br />• 4--11P LI-g V-4-41-4-(0-0 ?--,f)-- c -t,(:(4--r1^- OgiV\I-,2c, t <br />4), r,r, 4.1, 60 kiL7.-,4(r 1 0-0 (2-1k Sc}trt-K--+cl-- • <br /> <br />4 . nit 3 <br /> <br />, <br />it 4 <br /> <br />Unit 5 • <br /> <br /> <br />Unit 6 • <br /> <br />Specific Date Range of Information Requested: From to <br />2rUNDERGROUND TANK (MONITORING/REMOVAL) 0 DOG KENNEL <br />y6c-NDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT m <br /> OTHER CLEANUP SITE (NON-LOP) in FOOD FACILITY <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />0 DAIRY <br />0 SOLID WASTE FACILITYNEHICLE <br />0 WASTE TIRE <br />0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH <br /> <br />0 WASTEWATER TREATMENT PLANT <br />0 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL <br /> <br />0 PUMPER TRUCK/YARD/CHEM TOILETS <br />o TATTOO/BODY PIERCING 0 POOL/SPA <br /> <br />0 LAND USE APPLICATION SITES <br />0 MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 Am-5:00em - EXCLUDING HOLIDAYS. <br />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 />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 />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 />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 />END USE ONLY <br />If you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br />CUM .410,C <br />BUSINESS/AGENCY: