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I i SAN JOAQUIN COUNTY <br />- ENVIRONMENTAL HEALTH DEPARTMENT <br />SEP - F LUWo Tele hone: <br />East Weber Avenue, 3d Floor, Stockton, CA 95202-2708 <br />ENVIRU(i- ', r,T f{EALele hone: (209) 458-3420 Fax: (209) 464.0138 Web: www.sjgov.orwehd <br />PERI4i' VICES PUBLIC RECORDS RELEASE APPLICATkON <br />PAGE 01 <br />EHO LOG NUMBER <br />TENTATIVE' APPOINTMENT DATE: --Tim: <br />(Please allow 10 bmilss days from date of application submilnl - 'T enraCve only - ramt be confirmed) <br />© CHECK BOX To EXPEPITE REQUEST - $a5.00 FEE (CASH OF CHECK ONLY) - REQUEST PIRCC€SSEP INrr3 QUSIN'E35 DAYS <br />SIGNATURE OF APPLIC.A14T _ l` ( rGATE git, <br />UNR DISTFdBW770H G Unit E] Unit2 ❑ Unei3 ❑ Unit 0 Un6t5 <br />[a UnitE r_ CtFlvr (e Icetronrtfl�strJrnsps) <br />PILE ADQIdESS <br />Srreet0 S"Gt Name Clfy <br />-A <br />.. m <br />EHD USE ONLY <br />2. 374 o�A <br />_ Gp - <br />usrH <br />3. <br />4. <br />6. <br />6. <br />10.-- <br />SJ.1DCif1C Date Range of Information Pcumted: From to <br />yy�(�� ENVIRONMENTAL. HEALTH DEPARTMENT FILES <br />-����,P-UNDExIORouNM TANK (UST) CLEANUP SITE (LOPF>< ❑ HOUSING ARATEMENT 'KSOUD WASTE FAC1L1 <br />6TYnY€H:cLE, <br />0IMER CLEANUP S1rE(NON�LOP)-C OF000 FACILITY ASTET)RE <br />UNDERGROUND TANK(iMIDWORINGIREMOVAL)% ❑ DDC KENNEL G DAWY <br />HAZAg0009WA$TE GENEP TOR.1C 13 CHICKEN RANCH WASTEWATER TREATMENT PLANYX. <br />TYERED PERMITTED FACILITY ❑(IIICTELIHOTELPUMP?RTRUCKJYARv[CM0.i TDi.jM), <br />Q TATTOOIBODY PMRaNG 0 POOLJSFA ® LAND USE APPUCA77ON SITES <br />KMEDICAL WASTE FACILITY k ❑ OTHER (PLEASE SPFM") <br />WELL AND SEP71C PERMIT RECORDS ARE AVAILABLE FOR REYEw- Mo PAY-PmoAY &:o0 A.V,S:OOPM -EXCLUDING HOLIDAYS. <br />1. List up to ton 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 [2091464-0138 or mail to tie addrm <br />LndLCated gbove. Address ranges will not be accepteG— IRUOUditional assistance with file addresses, contact <br />the EHD. Applications received after 3:00 pm will be processed the next bvslness day. <br />2. The EHD Will notify the applicant If any EHD flies exist An appointment for review will be confirmed <br />approximately ten (16) days after receipt of application. The files will be hold for a maximum of five business <br />days for review. Appointments should be scheduled accordingly. <br />Sr A file that is actively being worked an by EHD staff may not be Imanc-cLiate6y avaNable for review, A new <br />application may be submitted when the file Is avallabie. <br />4. Any file not returned in the same condition aT released will be reorganized by EHD staff at the oxnense of the <br />appncant Future file reviews by the same applicant may require a S96.0(1 deposit prior to review. <br />PN a" <br />N1w. <br />qli3 <br />N <br />V1 <br />O <br />