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Sep 01 OS 06: 23p Pa Humphrey (55926-3408 P. 1 <br /> EHD USG NUMBER <br /> DATE REM D SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> E"i L006 304 East Weber Avenue,3`d Floor,Stockton,CA 95202-2708 <br /> MAP 1 Telepbone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ebd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> UT—PE APPLICANT: �1 SUSINESSIAGMCY. <br /> ADDRESS: c� OE7-rr n — <br /> PHONE(T): ssf-��7 -�< R�3 PHONE(2): FACSIMLE: _ <br /> TENTATIVE'APPOPITME11T DATE: - Tin*: <br /> xow - <br /> (Ples all10 brHDess days from date of al Wills0submKtal- Tenwft only-must be 1XHIM red) <br /> 0 CHECK BOX TO EXPEDITE REQU (93.00 FEE FASH OR HECK ONLY)-REQUEST PROCESSED 1113 BUSNESt-DAYS <br /> SIGNATURE OF APPLICANT DATE b <br /> uHrr DISTMOUT10N O uNt 1 0 UIM 2 0 Una 3 60.14 ❑UnN S 0 Unite 0 00—(rHoW"'CA lahnaps) <br /> FILE ADDRESS 3 u1�� EHD USE O <br /> Strom II stream Name CKY a <br /> 9 <br /> 2.4. <br /> 6. <br /> 8. <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FIL..E�"S' <br /> $UNDERGROUND TANK(UST)CLEANUP SRE(LOP) O Housno ABATEMENT FIPCSOUD WAVE FACE:nYNE1^DL_ <br /> 0 ammCLEANUP SITE(NON-LOP) 0 F000 FACHM FS WASTE TME <br /> S'UNDERGROUND TAKK(160HITORM01?EMOYAL) 0 Doc KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CNK:KPI1 RANCH O WASTEwATER TREATMENT PLANT <br /> )91'0 TIERED PERMRTEo FACILITY ❑MOTELMOTEt ❑PUMPER TRlICK1YAROICHEM TDOEn <br /> CO TATToofBooY PERCMG �❑e POOLISPA 9�LTA�p�pj 1J'6E APPLK:ATION SDES / <br /> 0 MEmcAL WASTE FAcurr ,2S OTHER(PLEASE SPEQFY) <br /> WELL AND SEPTIC PERMIT RECONOS ARE AVAILABLE FCR Rev"• MONDAY­FRIDAY 9:00 AM5*0ft - EX"M0 HOUDArL <br /> 1. List up to ten addresses in the space above. Select the type(s)of flies from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the.9-(kiltess, <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,eontEIct <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 confirmat] <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of 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 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 exFrense of the <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> am 4=401 <br /> +nos <br />