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DATE --- - -- oLo roc ULM <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DPARTMENT v <br /> JUN — n X005 304 East Weber Avenue,3`" Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)464.0138 Web: www.sjgov.org/ehd 1 <br /> EhMR�NPENT HEALTH <br /> PERMIT/SFRVICS PUBLIC RECORDS RELEASE APPLICATION pp <br /> APPLICANT: 1 e t t BUSINESS/AGENCY: e NcS1C <br /> ADDRESS:_ICE tt 0A !A!1L ,5A _ �_ S_QLC= _s t'(�0„lfC�f�ICA. 9- 4Sg <br /> PHONE(1): .QI(o 'at3t?� C4Nd-�' PHONE(2): 9VP`AtnSL _11CO FACSIMILE: CJIe $ Oaa1 <br /> TENTATIVE"APPOINTMENT DATE: Time: `gyp <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be oo _ <br /> CHECK BOX TO EXPEDITE REQUEST,-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED I <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑ Unit 1 t3W&AUn 9 Unit x D Unit 5 Una 6 ❑ Other(electronidlistslmaps) nG,� <br /> FILE A RESS <br /> City EHD USE ONLY <br /> Streets Street m _ <br /> 1. SY 1A WIll <br /> 2• a LIST <br /> 3. u TH W <br /> a. <br /> 7. _.. <br /> Specific Date Range of Information Requested: From 2AMFM to P E2ac Tr <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IIS UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 16 SOLID WASTE FACILITYNEHK:LE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 151 WASTE TIRE <br /> 'UNDERGROUND TANK(MONITORINCIREMOVAL) ❑DOG KENNEL E3 DAIRY <br /> VA2AR000s WASTE GENERATOR 0 CHICKEN RANCH 171WASTEWATER TREATMENT PLANT <br /> H <br /> TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑TArTOOIBooY PIERCHIG ❑POOOSPA Q LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REyIEw - MONDAY-FRIDAY 8:00 AM-5:00pm - EXCLUDING HOLWAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(_209)464-0138 or mail to the address <br /> Indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> END"412406 <br /> 1111106 <br /> TOTAL P.0] <br />