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MAR-11-200055(03:56 FROM: 919252946687 TO S4013B P.1/1 <br /> \ E ,'� EHD LOG NUMBER <br /> SAN JOAQT)IN COUNTY <br /> �C\ MAR 1 1205 ENVIRONMENTAL HEALTH DEPARTMENT S <br /> ��{ 304 East Weber Avenue, 3`'Floor, Stockton,CA 95202-2708 <br /> EN`11OME l ` N elephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> 71 <br /> PERMITIS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: V AW, /�( / BUSINESS/AGE�NCY: re- <br /> ADDRESS: <br /> B 1' <br /> ADDRESS: yy�� Y I,/OZ/ LGL^/`Y,'dn ca'd r. gJ 77 c <br /> �YJ <br /> PHONE(1 SZ -7'l I'A' PHONE(2)(-�4g 7- r 4j- FACSIMILE: <br /> 7 <br /> TENTATIVE`APPOINTMENT DATE: ArAO Time: , 005 <br /> (Please nfl <br /> allow 10 business days from date of application submittal-•Tentatt a only.must be comled) -- <br /> ❑ CHECK BOX TO EXPEDITE REQUEST.$93.00 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � DATE UNIT DISTRIBUTION DISTRIBUTION 0 Unit 1 Unit 2nit 3 nit 4 O Unit 6 E3 Unit 6 0 Other(electronic/lleta/meps) <br /> \ FILE ADDRESS EHD USE ONLY <br /> y Street# Street Name city <br /> V�r 1. O A,m Or F <br /> 2. <br /> 3. 1 <br /> 4. /J <br /> ti. <br /> 6. <br /> 7. <br /> An110. 1 <br /> Specific Date Range of Information Requested: From /9F; to 17K-Atm-�- y <br /> y ENVIRONMENTAL HEALTH DEPARTMENT FILES rl <br /> CI UNDERGROUNDTANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACIUTYIVEHICLE <br /> �9 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACIUTY 0 WASTE TIRE ARM <br /> "Z UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CKICKEN RANCH i'-M WASTEWATER TREATMENT PLANT Ir <br /> TIERED PERMITTED FACILITY 0MOTEUHOTEL 0 PUMPER TRUCKIYARDICHEMTOILETS <br /> 0 TATTOOIBODY PIERCING 0 POCUSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILASLE FOR REVIEW- MONDAY-FaIDAY 8:00 AM-S:OOPM • EXCLUDING HODDAYS. <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. AO <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed 4� <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 /> EHD44-02,04 <br /> 1IIUG< <br />