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1011/ 1b / 2OUt 14 : b3 2133800505 ENVIRONMENTAL PAGE 01 / 01 <br /> d <br /> SAN JOAQuIN COUN7'X EHDLOO NUMBER <br /> ENVIRON1VIENTAL HEALTH DEPARTMEN <br /> 2007 pho East Weber Avenue, Std Floor, Stockton, C1112011-F138 <br /> ENVINAMENT HEALTl4 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wwwsj V. 10 e <br /> PEWAT/SERVICES PU13LIC RECORDS RELEASE APPLICA ON <br /> APPLICANT: 1 BUSINESS/AGENCY: _ <br /> ADDRESS: /�:a2 WiLSI-til2F 1s L�Y7 GTF <br /> PHONE (1): 2« 390 - oSSS PHONE (2); T ( "i •- 3 nGP_ PAGSIMILE: l <br /> 3� '�� - OSoS <br /> TENTATIVE* APPOINTMENT DATE: Time: <br /> (Pieces allow 10 business days from date of application submittal - *Tentative only - must 4e confirmed)BOX 70 EXPEDITE REQUEST - n SN 0 K ONLY) - REQUEST PROCESSED IN S BUSINESS DAYS <br /> SIGNATURE, OF APPLICANT � DATE / S <br /> Electronicnformatlon: ❑ List ❑ Map — Description: <br /> FILE ADDRESS <br /> $treat Name EMD USE ONLY <br /> 9ereat$ <br /> city <br /> unit <br /> t . 25 Cw �, � �_ Srerav 3 <br /> 2. ❑ Unit2 <br /> 3. <br /> 4. Umt3 t\( <br /> 5. (� <br /> 6. F <br /> P <br /> It <br /> T. <br /> $, ❑ Unit <br /> 9. <br /> 1o. ❑ Units <br /> specific Date Range of Information Requested: From to <br /> ,.�/ � ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> }TMUNDERGR0UNO TANK (UST) CLEANUP Sim (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYA/EHICLE <br /> OTHER CLEANUP SITE (NDN-LOP) O FOOD FACILITY ❑ WASTE TIRE <br /> �.r�1NDERGROUNO TANK (MONITORING/REMOVAL) ElPOG KeNNEL ❑ DAIRY <br /> —E1-aaAZAR000S WASTE GENERATOR CHICKEN RANCH 0 WASTEWATER TREATMENT PLA rr <br /> E3 TIERED PERMITTED FACILITY MOTELMOTEL <br /> O TATTOO/BODY PIERCING t7 POMPER TRV4K/YARD/CHEM TDILETS <br /> • MEDICAL WASTE FACILITY POTHER (PLEASE SPECIFY) El LAND USE APPLICATION SITES <br /> WELL AND SEPTIC PERMITRECORDS ARE AYaLARLE FOR REVIEW . MONDAY-FRIDAY 11:00 AM-a:OOPM - EXCLUoING 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 (2091464-0138 or mall 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 Nies 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 immediately available for review. A new application may be <br /> submitted when the file is available- <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD start at the expense of the applicant. <br /> Future file reviews by the same applicant may require a $95-00 deposit prior to review- <br /> EHD USE ONLY <br />