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(�710 JOG oi✓u ri 01 <br />DATE �+v_�- -- SAN JOAQUIN COUNTY " . U <br />.��.._...... <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />q 2005304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br />ENV1R©NyENTelephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjg0v.arg/ehd 1=07%9 <br />I HEALTH <br />PERMIT/SFRVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT:_) BUSINESS/AGENCY, lv <br />__ ,N!3�Q <br />ADDREss:cAlt OA <br />9ES;l-7 <br />PHONE(1): _GI(Q 2155 t4kA'�-n1 PHONE(2): 9KQ 3(a:_ `i.l= FACSIMILE: Fj(La $Cna f31C''� <br />TENTATIVE" APPOINTMENT DATE: 10 i IZ� IDS Time: `qfr <br />(Please allow 10 business days from date of application submittal-'Tenrative only - musi be Ca _ <br />❑ CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED I <br />SIGNATURE OF APPLICANT DATE n , <br />UNIT DISTRIBUTION <br />❑ Unit 1 ❑ I Un 3 Unit; D Unit 5 iUnit <br />6 ❑ Other (electronicllistsrmaps) <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />7 WASTE TIRE <br />FILE AEORESSdo' <br />EHD USE ONLY <br />_ Street N Street .. City <br />1, <br />5i <br />❑ WASTEWATER TREATMENT PLANT <br />_ <br />2. O 1 �0 w <br />v4, <br />UST _ <br />- — <br />� W <br />177 LAND USE APPLICATION SITES <br />4. I O "U <br />S1_ <br />_ <br />5. <br />6. _.. <br />L10,7 <br />- <br />Specific Date Range of Information Requested: From „acm„,_-Z-) to 2mal� <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />Ild UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />9 SOLID WASTE FACILIWtVEHICLE <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />7 WASTE TIRE <br />UNDERGROUND TANK (MONITORINOIREMOVAL) <br />❑ DOG KENNEL <br />❑ DAIRY <br />y HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT <br />IFI. TIERED PERMITTED FACILITY <br />D MOTELIHOTEL <br />❑ PUMPER TRUCKIYARDICHEM TOILETS <br />D TATTOO/BODY PIERCING <br />D POOLISPA <br />177 LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-6:00PM - EXCLUDING HOLIDAYS <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 e <br />applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />EHD UA2-006 <br />111406 <br />TOTRL P.01 <br />(1�-O <br />