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F�D <br />i �AN .�OAQUI COUNTY EHD LOG tVi. MBER <br />SF.p 0 9 :1 i0 ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St, Stockton CA 95202-3029 562q5' <br />TbphOne: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/e <br />ER J!1 (/r LERV10EG PUBLIC RECORDS RELEASE APPLICATION <br />tom" <br />APPLICANT: :d _ t.T t � BUSiNESS1AGENCY: ^~ <br />,' _ - <br />ADDRESS: CiTY1STATEIZIP: t iyf� <br />PHONE (1): ) PHONE (2)_�7FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: _ Time - <br />(Please (Please allow 10 business days from date of application submittal - •TenlaBve r�njp - rnust be confirmed) f } <br />❑ CHECK BOX TO EXPEDITE REQUEST - 3 2 FEE (CASH OR CHECKK � E�T� ROCES5ED IN 3 B SINES D <br />SIGNATURE OF APPLICANT DATE <br />I <br />Electronic Information: ❑ List ap — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />1 <br />reet Name <br />-- <br />�p <br />( V <br />Ci tY <br />i Street #St1 <br />t 11 L3 at 1 <br />1. <br />...__..__._ <br />3. <br />PSI" <br />i 1 <br />I <br />, <br />6. <br />7. I <br />� <br />8. <br />------ _ ..._._ <br />D Unit 5 <br />�.._s- <br />i <br />nit 6 <br />oPCx;itiC vQtH marTg4 OT inTOn,nauon t<Gq UOStGd: From to T <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEA14UP SITE (LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE / ✓ IK�" - r <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY WASTE TIRE <br />UNDERGROUND TANK (MONrfORING/REMOVAL),K, ❑ DOG KENNEL DA;IRY wl It :5, 1`^� <br />HAZARDOUS WASTE GENERATOR ( ❑ CHICKEN RANCH WASTEWATER TREATMENT PLANT q -l0 .-l0 <br />TIERED PERMITTED FACILITY ❑ MOTELIHOTEL �PUMPER TRUCKIYARDICHEMICAL Toji-Eis <br />TATTOO/BoDY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />El MEDICAL WASTE FACILITY Q OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY $:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />1. List un 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) 454-0138 or mail to the address indicated above Address <br />ranges will not be accepter! - 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 (1 D) <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 />d. 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 />