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FROM JODI VANNEMAN FAX NO. : 4154793988 Oct. 08 2010 10:47AN P2 <br /> D EHD LOG NUMBER <br /> SAN ,JOAQIJlN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> U� 0 1010 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.or eh <br /> ENVIKUNIVIM I HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> P <br /> APPLICANT: A h1%e, /C,A,���BUSINESS/AGENCY: <br /> ADDRESS: �� Q,A'►�,�/r.L1K• Q - CiTYISTATE/ZIP: IR I <br /> PHONE(1): 5i• �INTM <br /> HONE(2): FACSIMILE: Ip <br /> TENTATIVE" ATE: Time: <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 El Map—Description* <br /> FILE ADDRESS EHD USE ONLY <br /> Q Street# Street Name City Unit 1 <br /> A W _- SOW 41+—e lot' 11_ o t� nit 2 <br /> 4. nit 3 <br /> 6 <br /> � 4 •7 <br /> 7... <br /> -... __. <br /> 8• �I Unit 5 <br /> `71 <br /> Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �ps �.,'�TNDFRGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICI.E �—f)h <br /> .'OTHER CLEANUP SITE(NOW LOP) ❑FOOD FACILITY WASTE TIRE <br /> OPRONDERGROUND TANK(MONITORINGIREMOVAL)tx�_ ❑DOG KENNEL ❑DAIRY <br /> ;�MAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH , WASTEWATER TREATMENT PLANT /0-640 <br /> TIERED PERMITTED FACILITY ❑MWEL1HOTEL i/U PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> El TATTOO/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> El MEDICAI WASTE FACII,ITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RE=CORDS ARE AVAILABLE FOR REy1Ew: MONDAY-FRIDAY 5:00 AM-5:00FM(EXCLUDING HOLIDAYS) <br /> 1. List up teD addresses in the space above_ Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)484-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EMD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The FHD 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 EHO 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 /> SHOUSE ONLY <br /> to-6 <br /> 5 <br /> o_ _ <br /> G <br /> EHD 49-09 ^- <br /> 07r29110 <br />