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�� 01't�Cliwi��� i ca liHi F' - i ca l Con PHONE N0. 510 6548635 JUL. 07 2111 08: 45AM P1 <br />0 ` f� SAN JOAQUIN COUNTY CHID l OG NUMBER <br />JUL, 011 ENVIRONMENTAL HEALTH DEPARTMENT <br />to, <br />600 East Main St <br />ENVIRONMENTAL HE 600 St. Stockton, CA 95202-3029 <br />PERM ITISERVICE ephone; (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgoV.Orq/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: BUSINESS/AGENCY: <br />ADDRESS: ���� <br />p y 1 G �� �j' �`" _ CITY/STATE./ZIP: <br />PHONE (1): �/p �s63 — PHONE (2): FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: UL 2S� sol � Time: <br />(Please allow 10 business days from date of Wpppilication ubmlttsl - *Tentative only • must be C0 flrmed) <br />El CHECK BOX TO EXPEDITE REQU T - $122 FEE (CARS CH5001-Y) - REQUEST PROCESSED IN 3 BUS)NESS CLAYS <br />SIGNATURE OF APPLICANT Xalzx2 -(f <br />Electronic Infonnation: Q List Lj Map — Description: <br />3 x`,11 <br />V� 1. <br />2. I q /( <br />f-� <br />3. <br />4, <br />5. 3 ) <br />6. t,.'q i <br />7. ?� <br />10. C(-�i <br />FILE ADDRESSree <br />Stt Name <br />7� <br />AlW <br />&-Z- Poe <br />') DATE %� <br />EHD USE ONLY <br />j <br />Unit 1 <br />A) 0 <br />— <br />Unit2 <br />-21fnit <br />�y <br />d. <br />4Unit <br />0 <br />SpeCMC Data Range of Information Requested: From to <br />ENMONMENTAL HEALTH DEPARTMENT FILES I�C� <br />9 -UNDERGROUND TANK (UST) CLEANUP SrrE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FAGLFFYNEHICLE <br />ET HER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE Lw <br />}© UNDERGROUND TANK (MOVORINGMEMOVAL( F1 DOG KENNEL ❑ DAIRY 1 <br />L1 HAZARDOUS WASTE GENERATO� - ❑ CHICKEN RANCHT!£RED PERMITTED FACILITY �) <br />�j ❑WASTEWATER TREATMENT PLANT <br />❑ MOTLLIHOTEL ❑ PUMPER TRUCKNAP010-iEMICAL TOILETS <br />❑ TATTOOBDDY PIERCING POOUSPA ❑ LAND USE APPLICATION SITE$ <br />❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-S:OOPM (EXCLUDING HOLIDAYS) <br />1, hist 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 th the address indicatedabove. Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the LHD. Applications received after <br />3:00 pm will be processed the next business day. <br />2. The END 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 END staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $122 deposit prior to review. <br />