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Sep 01 05. 013: 23p PaL Humphrey (559..26-3408 p. l <br /> EKG UJG NUMBER <br /> DATE RED SAN JOAQUIN COUNTY <br /> � ENVIRONMENTAL HEALTH DEPARTMENT 9 <br /> C006 304 East Weber Avenue,3'Floor, Stockton,CA 95202-2708 <br /> MAP, I Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIRON%IEN-( HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PE APPLICANT: V BUSINESWAGENCY: <br /> ADDRESS: C k1 A +",-- f-i't• rT . <br /> PHONem: 551-U7 z IR 3- PHOHE(2): FACSIWDLE: <br /> TENTATIVE'APPOWTIAENT DATE: Time: <br /> eat.Bow <br /> (Pllto ness busiGaye from date oI tp D.Wan aub,oRtal.•Tenawe only-mutt be Confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQU b9�.eD FEE ASH OR HEC(ONLY)-REQUEST PROCESSED IN 3 BUSINESS;DAYS <br /> SIGNATURE OF APPLICANT DATE --//5/ <br /> UNIT DISTMWT10N 0Unit 1 0UMt2 ❑UnKS OU 4 OUnitS O Untie Cl Oawr(ekKIT001CA813hnept) <br /> FILE ADDRESS ) 3-O L� EHD USE O <br /> sst.t! Sheet litems City a — <br /> 1. t0hr x r �^ <br /> 2. <br /> 3. — �• /� - 3y <br /> 4. H �. <br /> 6. <br /> 7.. <br /> 8. <br /> 10. ` <br /> Specific Date Range of ktformation Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> AS UNDERGROUND TANK(UST)CLEANUP SrtE(LOP) 0 HOUSING AOATriiew 'KSOLIO WASTE FACLJTYIVEI - <br /> 0 OTHER CLEANuP SrtE(NON-LOP) 0 FOOD FACKTIY Rt WASTE TIRE <br /> $UNDERGROUHD TAHK(WHrrOw G/REMOVN.) ❑DOD KENNEL ❑DNRY <br /> �HAWL5 WASTE GENERATOR OCHIOKEN RANCH ❑WASTEINATERTREATNENTPLANT <br /> HAVADOU <br /> ❑ pERMTTTFJI FAc�nY 0 MOTELAIOTEL Cl PUIrPERTROCKPYARDICHEM T�ML"_TS <br /> 0 PoDL/3PA 9E APPLICATKNI BrtEs <br /> 0 W� WASTE FACUOY ZSQmER(PLEASESPECIFY) 4 <br /> WELL ANDSFPnC PERMR RECORDS ARE AYAILAsLE FOR REVIEW- MDNDAY4=RmAYs:ra AMZ:0QrM - ExMWIND HOUDArL <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(2091464-0138 or mail to the address <br /> indicated above. Address ranges w81 not be accepted-for additional assistance with file addreew s,contact <br /> the EHD.Applications received after 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 <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of fhre business <br /> days for review_ Appointments should be scheduled accordingly. <br /> 3. A file than is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be 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 <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. T <br /> END 48-024N <br /> +Huns <br />