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RECEIVED <br /> SAN JOAQUIN OCT 27 zoo <br /> Environmental Health Department <br /> J N T V —VIRONMENTAL HEABLIC RECORDS RELEASE APPLICATION <br /> ENL�� <br /> ,1 DEPARTMENT EHD LOG NUMBER: v `tel <br /> APPLICANT K > BUSINESS/AGENCY:- ( <br /> _�� _ _4�s-'• , AJ <br /> 95 3ADDRESS <br /> PHONE 111 CITY/STATE/ZIP: _ / �y <br /> tLPHONE (2): <br /> FAX OR E-MAIL: _ - <br /> �lease allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. 2�— , <br /> SIGNATURE OF APPLICANT 'u— i-:L' DATE _ _ ` '� -" <br /> 1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the type(s)offiles from the <br /> Fiat below by checking the appropriate box(es). Al least one file type MUST be selected. Fax to(2091464-0138 mail tO She_ <br /> address indicated below,or email to info0aicehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance In Identifying the nature and content of EHD records,please contact EHD at the number noted below. <br /> 3. 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 be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <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$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: List❑Mg_�—Description: <br /> Specific Date Range of Information Requested: From 1 — 1 l to tJ C)"i <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES (Spedac addressee ony,address ranges will not be accepted) EHD USE ONLY <br /> 01u 2ro„nd Tank War) street a Street Name City <br /> CYenup Sd(LOP) ❑CaRwxLa <br /> p xr siwmv SAe(NoMop) S 1-\ E `I v .l c A 1a1 I <br /> C 1lazrdow wa ❑DA1fii" <br /> 0 Tired Pwrnticd FUMY 2 <br /> QAtrovapraaW TRA t`_i <br /> PWa <br /> UST FMoMorPq I RV=V*4 <br /> Q-Nezrdo a maiei 7 <br /> Spa/Rel a Rnpmee O WATEROwun <br /> Solid WSW FWNy/vehkAe e <br /> Food Fealty <br /> r� Sec Mnr..na, <br /> Pool/Spa <br /> I] a �fjlll V U� <br /> D.kr ( ` <br /> UM UWApptcakoR SO" / ❑NOUBdG <br /> E]Septic Purgr Truck/ <br /> yard/ChrRical TWON <br /> Wq <br /> f__� <br /> a .w lr Trestw1d Ptah ❑CUPA <br /> O Kw*tg Abstern l y ST <br /> I NM I NW <br /> MWAVOd 0 CUPA <br /> Ch Wan Ra h I Dog KwwiW UST <br /> e <br /> Mod"I waste Facility <br /> Tmft&BOdy PiwckV ID SOLO WASTE <br /> Waala Tire 9 <br /> co"ia i AocWmex, <br /> Dew(PMaaa Spadly): <br /> 10 <br /> »bnrEe AREA EHD USE ONLY" <br /> 0. YWO <br /> vi 'IO-Li- A-02 the e.va <br /> Records rovided Staff-PPR Com late. stafNama: 2!L) <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjoehd.com <br />