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-- ------- -- - --------...---- ------ --------------------- <br /> - - <br /> -------- ---- -- - --- - <br /> .---- - -- - ---------- --- .. - . - ---------------------- --- ------- --- ---------- ---- <br /> DATE RECEIVED EHD LOG NUMBER <br /> FE <br /> SAN JOAQUIN COUNTY <br /> U ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> APR 19-LD1 <br /> elapKone:-(209)468=34217Fax-(209)464=0138-Web: www.slgov.org/eh-d <br /> ENV RONMENTALHEALTH <br /> PERMIT/SERV CES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: S� d��r�r� BUSINESS/AGENCY: <br /> ADDRESS: �. f �i CITY/STATE/ZIP: j;,j,,Jen � K 9 S'L34 <br /> 9/ 70E-0392 <br /> PHONE(1): 0 PHONE (2): Q29)&7 /(Q� FACSIMILt 17 /10 <br /> TENTATIVE*APPOINTI ENT DATE: Time:ly- <br /> (Please allow 10 business days from date of application submittal-*Tentative onmust be confirmed) <br /> El CHECK BOX TO EXPEDITE REQUEST- (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE G- 79 yj <br /> Electronic Information: El List Elap—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name City ❑Unit 1 <br /> 1D <br /> 2. <br /> J 3. [IUnit 2 <br /> 4. COmLdUnit 3 <br /> 5. I T- <br /> 6. It <br /> Unit4 (6/j, <br /> 7. <br /> 8. <br /> ❑ Unif 5 <br /> 9. <br /> 10. El Unit Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTETIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)If( El FOOD FACILITY - ❑DAIRY 3c1,Zt���3 <br /> ABOVEGROUND TANK �� [-]CHICKEN RANCH)DOG KENNEL TREATM <br /> NT PLANT <br /> ER HAZARDOUS WASTE( RDOUS MATERIALS Al WASTEWATER <br /> y\ ❑MOTELIHOTEL ElPUMPERTRUCK(YARDICHEMICALTOILETS <br /> F-1 TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY B:00 AM-5:OOPM(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 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 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 /> .3. A file that is actively being worked on by EHD 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 applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review, ***BOXED AREA-EHD USE ONLY*'* <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br />