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-E RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> DECEIVED EwvIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 DV <br /> JAN 9 3NIWhTTotne: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> DMRON <br /> PERMITLPISERVICESIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C A05 lBUSINESS/AGENCY: <br /> ADDRESS: 9_' Tf 5 /j"—_f_ CITY/STATE/ZIP: t, p ja'?-c7 <br /> PHONE (1):(Ug ) uon -lab-� PHONE (2): <br /> FACSIMILE: <br /> TEVTA 71IVE*APPOINTMEN TE: Time: <br /> (Please allow 10 busine s day from of submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE QUEST- 12 EE(C R CH LY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map - Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> Unit1 <br /> 3. - _-_ _ —_ — — _ __ Unit 2 <br /> 4. J <br /> 5. L/ Unit 3 <br /> - I <br /> 6. — J� <br /> 7. - — - --- —.._ ., _ Unit4 <br /> 8. <br /> g ❑ Unit 5 <br /> 10. <br /> ❑ unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES�KI ^ -1e <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE 1- <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL ❑DOG KENNEL El DAIRY <br /> HAZARDOUS WASTE GENERAT1ORpS ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT I' -�Z <br /> TIERED PERMITTED FACILITY — l ❑MOTELMOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY OMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> I. ListuD 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 expense of the applicant. <br /> 2Future file reviews by the same applicant may require a $125 deposit prior to review. <br /> EHD 48-06 <br /> 811111 <br />