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110 <br />RFDD SAN JOAQUIN COUNTY EHD LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />0L ( 3 0 2008 600 East Main Street, Stockton, CA 95202-3029 Z <br />Telephone: (209) 468-342 Fait (E09}464 0138 Web; wwwsjgov.oro/e <br />ENPERMITMENT ISERVICES H A ` iii <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />ADDRESS: ZTi[sr —7--.Iglleleis�G(Ih__ %Ae9 Cltylstate/Zlp <br />PHONE (1): �S�-' - /.5�.,- PHONE(2); FACS IMILE:6v5E-2f.3 <br />TENTATIVE' APPOINTMENT DATE: _ _ I 3�U-F T)mo: /0A -PW <br />(Please allow 10 business days from data of 2ppliettion submittal --Tentative only - must be Confirmed) <br />17 CHECK BOX TO EXPEDITE REQUEST <br />SIGNATURE OF APPLICANT <br />Electronic Information: <br />1. <br />2. <br />3. <br />4. <br />s. <br />8. <br />9. <br />10. <br />List Lj Map - <br />'ILE ADDRES <br />Street Name <br />R <br />rf <br />p <br />h <br />P <br />It <br />VI <br />It <br />...IL <br />Unit4 <br />ll <br />1f <br />11 <br />unit S <br />Il <br />° <br />u <br />a <br />tt <br />It <br />�1,04 Or <br />R <br />Range of Information Requested: From <br />ENVIRONMENTAL HEALTH <br />Y) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />DATE <br />FILES <br />(] UDIt i <br />❑ <br />1.102 <br />Unit4 <br />❑ <br />unit S <br />unR6 <br />�1,04 Or <br />it VNUERGROUNDTANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT ❑SOLID WASTE FACIUTY/VEHICLE <br />XOTHER CLEANUP SITE (NON -LOP) ❑FOOD FACILITY d�i'E3 '/ G <br />UNDERGROUND TANK(MONITORINGIREMOVAL) VOL t9 DOGKENNE[' ❑DAIRY WASTE TIRE W �]/ <br />XHAEARDOUS WASTE GENERATORd� ❑ CHICKEN RANCH d WASTEWATER TREATMENT PLANT i <br />© TIERED PERMITODY TED FACILITY ❑ MOYFUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS AIIG 5c�i <br />13 MEDICATATTOOL WASTE FACILITY <br />❑POOLISPA 11 LAND USE APPLK:ATION SITES �y <br />Ia MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) g{1O1Q <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:0OPM <br />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 (200) 454-0138 or mall 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 filed exist. Anappointment for review will be confirmed approximately ten (10) <br />days after receipt of application. The files will b' 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 5105 deposit prier to review. <br />�e, EHD USE ONLY <br />