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<br /> ■ ' '..... SAN JOAQUIN COUNTY'.
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<br /> ENVIRONMENTAL HEALTH.DEPARTMENT
<br /> 02.0-14. 186$ East Hazelton Ave.nue., Stockton, CA:9.529.—.0232
<br /> Te1ep.hone; :(209).46.8-3420..Fax:.(209).4E4-.0:1.38 Web: www:sjgov.org/ehd
<br /> 5.NV1R0NMENTAL HEALTH°) , Y
<br /> PERMITSERVi
<br /> I CHs: P.UB.LLG :RECORDS RELEASE APPLICATION
<br /> —APPLICANT. 'd �VQ:IoszYr.�.•I:'Rdd� FF rc .i naOdW.:�an.age
<br /> :':ARDRES:S 1.J .' W_ L •amino ' e # .2 "•.C(TY/S.TATEl,Z1.P:.:S':a.i✓x rxl � to 0 9 :53 .
<br /> 'RHQNE(�.Y 'g -6-444-'x.654.
<br /> .:PHONE (2):. FACS(MILE:.'g
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<br /> Please.allowl.0 business:days.from date'of-application submittal fo.r the:.reco:rds to be.available..
<br /> :S.taff`will.c.ontact'you to.a.rrange.an appointment date.:and tlme:to reviewlhe requested-records.
<br /> GHECK OX.T•Q.4XP,EDi T_QUEST'-$1251F 9-:.(CASH OR CHEC.;ON,LI`L�REQUEST RRp.OB S :IN.3;BUSINESS.DAYS
<br /> S.10N•ATURE. F;AR:RLICaNT'
<br /> DATE
<br /> Ele:ctro.nic.:l.nformatio.n:, ' ❑ List❑ Map�.Descri.ptio.n:
<br /> I+ILE.ADDRESS'
<br /> EHD;USE,QNLY.:
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<br /> ssi�� ®°units
<br /> SpeciffcQate.Rangeof.Informati.'on:Requested: From
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<br /> E JRONMENJ LT NT RLES,
<br /> [UNDERGROUND TANK.{U$T�.:CtEANUR SITE(LOR) .: '' '.❑MEDICAL WASTE FACILTTY.• t5•
<br /> • ®$..OLIDWASTE.FAC.UTYNE OL. I�•
<br /> 0-fHER.CLEANUP.SiTi; N0wLOP) ❑-HOUSING.ABATF-N1ENT
<br /> { :]WASTE TIRE • •'-.., 1 `
<br /> UNRERGRQUND TANK.MQNfi=NG/REMOygI,) ©.:FpQD F{iCIL[fY : ❑.DAIRY i 1 ;j
<br /> :®A.EiOVEC�ROUND TANK '.y
<br /> Q CHI,CK6ti IwGHI I�OG.}fENNEL ❑WASTEYYf{TER.Tf2EATMENT PLANT 5'•
<br /> IMHAZARDot1S:WAsTE(HAZARpops.MATERIAIS „ ' • ❑'.MOTEL/HRTEL- P TRUCK/YARDJ EJYIIC • `
<br /> :. TIERED RERMITTED.FACILII`.Y: : A
<br /> ❑:P.00LISPA. �LAND:US9:A0.PLICAt16h SITES. L T
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<br /> . • .❑TATTQ01$ODXPIERC:ING •
<br /> - �,�EOMRLAINTjRESRQN$E RECORDS"��� �.:Q.THER{FLEA$E`.SFECIPO. "•
<br /> X Wla,;4r►p.SEPTIC:RERM,IT.RE.CORDSARE.AYAILABLE FORREYJEW: MONDAY-FRI.OAY:8IJO:AM=SQOPM(EXCLUDING.HO,LIDAY_S)
<br /> 7. List up to ten addresses.in the"space above. Select the type(s)of files from the fist above by,Ghecking the appropriate
<br /> box(es). At least.one.file fyp.e-MUST be selected. Fax to(209)464013.8 or-mail:to the-addre.ss.fndicated above Address
<br /> ranges:will'.ilot.be:acce te.d,,A_. licatio.ns.received after:3.00• .m.will be. roceased the next business day,.
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<br /> .2: .For assistance.in identifying the nature.and.content of.EHD records, please contact EHD.at the number noted above. :
<br /> :3..The.EHD will notifythe applicant.if:any EHD files exit. 'An a.p.pointment:for review-will be confirmed approximately:ten(1U)
<br /> ' :days after receipt:of application: The files wiil,be held fora.maximum of five:bvsiness,days,for review: Appo•ntments
<br /> —should be scheduled accordingly,
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<br /> .4: Any file not-returned.in the same condition as released:will:be reorganized by EH.D staff at-the ex.pense:of the applicant.
<br /> Future fife.reviews.by the same'applicant-may require a.$92S.'d.epositp.rio..r.to review....*-**.BOXED AR.EA:-EHD.US.E:ONLY***�
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