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DATE RECEIVED � e rltr LVli Nunnatrc <br /> RE <br /> C E I\f 1"IDJ U SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUN 7005 304 East Weber Avenue, 3`a Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> EAV1R0WME N'l' H ALT A <br /> PERMIT/SIRVIuCS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ! -P BUSINESSIAGENCY: <br /> ADDRESS: G e <br /> PHONE(1): elf 3�r 7 PH NE(2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 Unit 3 nit 4 0 Unit S ❑ Unit 6 13Other(eiectronicllistslmaps) <br /> dov <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Nam City <br /> 2. 44 <br /> 3. k <br /> 4. <br /> 5. IF <br /> 6. <br /> 7. <br /> Specific Date Range of Information Requested: From to <br /> ; <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 4UNDERPROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT Q SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> lUNDERGROUND TANK(MONITORwGIREMOVAL) 13DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMmmD FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LADED USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> t <br /> !I <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEIM - MONDAY-FRIDAY 8:40 AM-5:00PM - EXCLUDING HOLIDAYS. Ir <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 209 464-0138 or 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 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 five business <br /> days'ifor 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 submitt4w hbn 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. { <br /> EHD 48.02-006 <br /> 1114MS <br />