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0 0 (1-.- <br /> SAN JOAQM COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> L)c 304 East Weber Avenue,3'd Floor, Stockton,CA 95202-2708 <br /> EidVlr,Of l,v <br /> \ ,>^f�I_i HFLA JKTelephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> 2. 50'( <br /> PERM,f i/SERVIGES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: �111��}- Q(� �f (�L"r^ f3' <br /> ADDRESS: L-�p 7��/,�,', S !CIL � <br /> PHONE(1):����J �'¢I10% PH NE(2):1 ---n_C:;L��Q Q{ F CSIMILE: ( ` 414 f <br /> TENTATIVE"APPOINTMENT DATE: . LVQeil (j± Time: Q <br /> (Please allow 14 business days from date of application submittal-"TenNffve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQU T-$93.00 FEE(CASH-OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT - DATE —� <br /> UNIT DISTRIBUTION ❑Unit 1 ❑ Unit 2 ❑ Unit 3 ❑Unit 4 ❑Unit 5 ❑ Unit 6 ❑ Other(electronle/Ilsts/maps) <br /> FILE ADDRESS <br /> Street Street Name cm, EHD USE ONLY <br /> 4. <br /> 7: <br /> 9. <br /> - <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> XOTHER CLEANUP SITE(NON-LOP) ❑Foot)FACILITY 0 WASTE TIRE <br /> JY UNDERGROUND TANK(MONITORINO/REMOVAL) ❑DOG KENNEL In DAIRY <br /> .�HA7ARDOUs WASTE GENERATOR ❑CHICKEN RANCH ❑VVA9TEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER ASTRUCKRA TREATMENT <br /> PLANT <br /> 0 TATToOBODY PIERCING ❑POOL/SPA C3 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONOAY-FRIDAY 6:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the type(s)of flies from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mall 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 the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHo 48-02-008 <br /> 1/14MS <br /> Z00� <br /> QNyI?It�O gI2ILvif03� Tfif £99 OTS gvd 90:tT JVS 20/6T/TT <br />