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DATE RECEIVED - EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.orgleh <br /> /1 <br /> PUBLIC RECORDS RELEASE APPLICATION ,.-T- <br /> APPLICANT: Cof,I '1: BUSINESSIAGENCY: Fhef�r <br /> ADDRESS: OYLD - k CITYISTATEIZIP: <br /> PHONE(7): 116 NSU 0z 7$ PHONE(2): FACSIMILE: V6 Yeti-nAn3 <br /> TENTATIVE"APPOINTMENT GATE: Time: <br /> (Please allow to business days from data of application submetal-'T*m%dm only-must be confirmed) <br /> ❑CHECK DOx TO EXPEDITE REQUEST- Y'$1"-15.0_0 FEE(CASH OR CHECK ONLY)-REOUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT L„i '2L ' DATE 72-6-b 9 <br /> Electronic information: ❑List ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> nStreat6 Swot Name city CI Unit1 /(�\ <br /> iOC I Q tl \ <br /> 2. ❑ <br /> 3. <br /> 4. <br /> 5. <br /> 8. Unb4 <br /> 7. <br /> B. ❑Unit 5 <br /> 9. <br /> 10- 0 Units <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES yfi �� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILRYNEHICLE Z <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD rACIHTY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONIrORIN EMOVAL)X El DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT t" <br /> TIERED PERMITTED rACLRY,91` ❑MOTELIHOTEL ❑PUMPER TRUCK11FARDICHEMICAL TOILETS �� 1 <br /> ❑TATTOOIBODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8:00 AM-5:OOPM(ExCLUDING HOLIDAYS) <br /> 1. List u0 to ten addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one Tile type MUST be selected. Fax to(209)454-0138 or mall to the address indicated above. Address <br /> ranges Will net be accepted-for additional assistance With flle 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 EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will behold 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 EHD staff may not be immediately available for review. A now 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 applicant <br /> Future file reviews by the same applicant may require a$115.00 deposit prior to review. <br /> END Use NAY <br /> 'If you need further assistance please eantdct blane Martinez a (209)468-3425 directly. Thank You` <br /> END'18-06 V31009 <br /> l00/L0012 XVj C9 El BOOZ/90/80 <br />