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APPLICANT: <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Mair, Street, Stockton, CA 95202 <br />2 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web; <br />bor5 <br />PUBLIC RECORDS RELEASE APPLI 101 <br />EHD LOG NUMBER <br />'✓+' w / BUSINESS/AGENCY- <br />ADDRESS; filz D121 Ue <br />PHONE (1): S PHONE (2): (L/pL7l2 FACSIMILE - <br />TENTATIVE* APPOINTMENT DATE: a �- �'� , Arm_ 1QQ <br />(please allow 10 business days from date of application submittal `-yrenttative'on ylmmust be confirmed) <br />17 CHECK BOX TO EXPEDITE REQUEST - $95.00 FEE (CASH OR CHECK ONLY <br />SIGNATURE OF APPLICANT <br />Electronic Information: ❑ List ❑ Map - Description: <br />- REQUEST PROCESSED IN 3 BUSINESS DAYS <br />DATE 2- —Q <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />TI"UNDERGROUNO TANK (UST) CLEANUP SITE (LOP) <br />CHER CLEANUP SITE (NON -LAP) <br />2DERGROUND TANK (MONITORING/REMOVAL) <br />❑ HAZARDOUS WASTE GENERATOR <br />❑ TIERED PERMITTED FACILITY <br />13 TAYYoo/BODY PIERCING <br />❑ MEDICAL WASTE FACILITY <br />❑ HOUSING ABATEMENT <br />❑ FOOD FACILITY <br />❑ DOG KENNEL <br />❑ CHICKEN RANCH <br />MOTEL/HoTEL <br />POOL/SPA <br />❑ OTHER (PLEASE SPECIE <br />❑ SOLID WASTE FACILIYYNEHICLE <br />❑ WASTE TIRE <br />LJ DAIRY <br />D WASTEWATER TREATMENT PLANT <br />t7 PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ LAND U5E APPLICATION SITES <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:OOPM - EXCLUDING HOLIDAY$. <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 IEHD 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 EMD 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 appllcant. <br />Future file reviews by the same applicant may require a $95.00 deposit prior to review. <br />FHD USF ONI V <br />TO 30Vd NAS Xdl 31d1S N39-109 GZek998800 80:9T LOOZ/ZO/80 <br />