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1 \ COUNTY <br /> y EHD LOG NUMBER <br /> SSAN V <br /> OL''�.Q.f.711\ CO VL\1 1 - <br /> ENVIRONMENTAL HEALTH DEPARTMENT .. <br /> JAM 0 4 2007 304 East Weber Avenue, 3d Floor, Stockton,CA 95202-2708 <br /> ENVIRONMENT HEALTH Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMITISERVIGES 10 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: _ p 1 SFS�,.3����1 e W e�I•J• BUSINESSIAGEWY: <br /> ADDRESS: ALL <br /> PHONE(i): ��2- 2Z_- PHONE(2): r p <br /> -�-7 j6S% 5 FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-•Tentative only-must be confirmed) <br /> 0 CHECK BOX 70 EXPEDITE FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 B SiNESS DAYS. <br />�I <br /> SIGNATURE OF APPLICANT DATE �b� <br /> r Electronic Information: ❑Li <br /> st❑ Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name City ❑ Unit 1 <br /> 1• 0 S I�.�vt.� S'fiil <br /> t 2' ZSR T ❑-unit 2 <br /> 4, <br /> 'r k U <br /> ol <br /> 5. nit 3 <br /> S Ij.l <br /> a <br /> S <br /> s <br /> 6. A'4 <br /> ILI <br /> T- <br /> 8. 0 "Unit 5 <br /> -9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Re <br /> quested:From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UND RGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT O SOLED WASTE FACILITYI;lfEHICLE <br /> PTHER CLEANUPSITE(NON-LOP) Q FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONMORINGIREMOVAL) 0 DOG KENNEL 0.DAIRY <br /> ,XHAZARDOUS WASTE GENERATOR 17 CHICKEN RANCH C7 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEIJHOTEL 17 PUMPER TRUCK/YARDICHEM TOILETS <br /> 13 MEDICATATTOOL <br /> WASBODY PIERCING ❑POOL/SPA ©LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY (3 OTHER.(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVEEw - MONDAY-FRIDAY 8:00 AM-5:00PM - 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 /> 4 Any file not returned in the same condition as released will be reorganized by EHD staff at the ekpense 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 />