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y7 <br /> [uvu [ Diriri 'UNUUK LAKIH IKH <br /> N0. 5926 P. 2 <br /> �'�AY�'HE�EIIIFDT`� <br /> •' EHD LOG NUMBER <br /> SAN JonQTmv COUNTY <br /> ENVIRONMENTAL HEAL iaDrPA[tT1ENT HEALTH 304 EastWeberAvenue, 3(Floor, Stockton,b: 95202-27082537 <br /> P- sl r,,,U� i. Telephone: (209}468-3420 Fax:(209)464.0138 Web:wwwsjgov.org(ehd <br /> rRfs�: �,,��.Il�!CE., (..., <br /> PCJBL C RECORDS RELEASE APPLICATION <br /> 7ADORnS: <br /> NT: � y�/ /� N SIN AGENCY: r�R' <br /> pY/ 1l �tl):aoA 7D <br /> PHONE(2): .ZOCJ- of— peel- <br /> ACSIrA11E: �-�'I ;Yt' <br /> TENTATIVE*APPOINTMENT DATE- d D(Q I '3oPm <br /> (Please allow 10 business days from d a ' <br /> Daimon subittal TTime:m <br /> Ten XWC only-must be rontinned) <br /> d CHECK BOX TO EXPEDITE RE T-$93.0 FEE( CHECK ONLY)-REQUEST PROCESSED IN j BU TNESS DAYS <br /> SIGNATURE OF APPLIC T 0� <br /> DATE <br /> UNIT bIsi UBUTION ❑Unit 0 Unit ❑Unit Unk4 ❑Unit t7 Unit 0 Other(clacboniD/lists/maps) <br /> FILE ADDRESS <br /> street Street Name Ky F.HDUSE ONLY <br /> FTA( <br /> 2. t �( <br /> 3. <br /> 4. t <br /> 6. tn�o p s <br /> T. 7a <br /> 8 i7 i"vLotzc "n a ALA <br /> ®c_._. <br /> 10. 2p <br /> specific Date Range of Information Requested:From to <br /> �J ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,C�,UNDERGROUNO TANK(UST)CLEANUP STM LOP ❑ �/ <br /> 0r1ER CLEANUP SrrE(NON-LOP) (LOP) <br /> ❑FOOD FA LnY HENT I slut?WASTE FApLnYNEmiaLE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) 0 FOO KENNEL ❑WAM TIRE <br /> HAZARDOUS WWE GENERATDR ❑Doc KaN RANCH ❑DAIRY <br /> TIERED PERMN7ED FACILnY ❑CHICKENMOTELIRANOTEL ❑WASTEWATER TREATMENT PLANT <br /> C3TATTOOISCDY PIERCING [3POOLISFA PUMPER TRVCK/1'ARDR:HEM TOILLTS <br /> r'MEDICAL WASTE FACIUTI• ❑OTHER(PLEASE SPEQFY) LAND USE APPLICATION SITES <br /> WELL AND SEPTTC PERMIT RECORDS ARE AVAILABLE MR RENEW. <br /> MONDAY-FWDgY 8:00 AMS:OOpN EECLODING HOLIDAYS. <br /> 1. list up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(2091464-01311 ar mail to the address <br /> Indicated above. Address ranges will not be accepted—for additional assistance with file addresses, contact <br /> the EHD. Applications received after3:00 pm will be processed the next business day. <br /> the <br /> cant <br /> le$exist An <br /> 2 The EHD approximately ten(p)day Rafter Ifany <br /> of pplication. The files w I lbe held or a mnt for review lll aximumnof 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 or review, A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the some condition as released will be reorganized by END 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 /> VnA <br /> EHD 0424 6 � <br /> tha6z <br />