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' DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> EG" <br /> � D ENVIRONMENTAL HEALTH DEPARTMENT <br /> '' '' 600 East Main St. Stockton, CA 95202-3029 <br /> le hone: 209 468-3420 Fax: 209 464-0138 Web: www.s ov.or /ehd <br /> OCT l 1 z(��1 p ( ) ( ) �g g <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT SERVICES <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: 4,,v,,, (f---T- CITY/STATE/ZIP: 7_U2 L v 6A <br /> PHONE (1): "r Yds- �-+4:3 PHONE (2): Z orl 6 4 - /i 1 1 FACSIMILE: <br /> TENTAT/VE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST 1 55 FEE(CAS OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> IZZ <br /> SIGNATURE OF APPLICANT r z DATE <br /> Electronic Information: ❑ List❑ Map— Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City [:] Unit 1 <br /> I 1• �z l 2 N C W1 71 <br /> � <br /> 2. 6 NA ,'4ej)'L" �' C/<TO — �. ❑ Unite <br /> 3. <br /> 4. --- — nit 3 (� <br /> 5. (� <br /> 6. 2rUnit 4 <br /> 7. <br /> 8. ❑Unit 5 <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> y ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Q G�IJbERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE �\ <br /> ❑'OT ER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> ❑;11NDERGROUNDTANK(MONITORINGIREMOVAL).V ❑ DOG KENNEL ❑DAIRY V"1o,��l <br /> ARDOUS WASTE GENERATOR�Y F1 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY-- \ ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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'mm d'ately av ' able for rev"�. Anew applic t'o�ma e <br /> 'y ¢ lfy6 - <br /> submitted when the file is available. I�� ��� . 111-� +11 �I�r1 f�1 , 11� Z')� h r ,,��y5`f)�� <br /> as released n be reor-�nli�-e 1` std iC li, �'e bT fh�l v lIC1nt.�y� <br /> 4. Any file not returned in the same condition g P Pp <br /> Future file reviews by the same applicant may require a$125 deposit rior to review. 10.Z0 + e „n 3LI23,10-1-7-11 �Z Qld <br /> ' a EHD USE ONLY 4W ,n (4- le. ' <br /> Sal -ro112 la j 4 t * _33 <br /> us n & <br /> 10-I .,11'. - II 11 t-I 5 4- 8 U rpt <br /> EHD 48-06 6 100 � • a 3J-i�•(d�1 f0rAR U''1-f 6 LE *k S 1A use 12 y _ <br /> !,u End;��QYl��• <br />