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R p =�J I�;�� • • <br /> • EHD LOG NUMBER <br /> �tiJ L� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JAM 0 4 2007 304 East Weber Avenue, 3`4 Floor, Stockton, CA 95202-2708 <br /> ENVIRONMENT HEALTH Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 'E:C'F "e y)w 6 0 BUSINESS/AGENCY: C q V <br /> ADDRESS:— �Z Z r 1�..9 � QIL <br /> PHONE(1):- �S2— —12 G7j PHONE(2): ! �-7 U 1 ' FACSIMILE: <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�j 9 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 B SINESS DAYS <br /> SIGNATURE OF APPLICANT �/ I _ DATE 1 65-1c)--- <br /> Electronic <br /> 5-1d"1Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑ Unit 1 <br /> 2. S ❑ Unit <br /> 3. -230S- S eP g �J <br /> 4. S 2QGL S t'iiilUnita <br /> 4- ' SaFs <br /> 6. Unit 4 <br /> 7. <br /> g, - ❑ Unit 5 <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES gg� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACLLITYIYEHICLE <br /> UTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR <br /> E3 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 17 TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUGUYARD/CHEM TOILETS <br /> •MEDTATICAL WASODY E FACILIERCINGTY <br /> 11 POOUSPA ❑LAND USE APPLICATION SITES <br /> CJ MEDICAL WASTE FAGLITY ❑OTHER(PLEASE SPECT <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 6:00 AMS: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 /> 'I <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$95.00 deposit prior to review., <br /> EHD USE ONLY <br />