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A r. 9. 7012 2: 25Pv -q?, :t <br /> PATI RECEIVEQ Ant <br /> EHD LOG NUMBER <br /> SAN JOA UIN :OUf Gz . <br /> RECEIVED EN IRONMENTALSALT b"EP; RRTMENT <br /> 600 Fast Main St. Stockton, CA 95202-3029 <br /> Za17_ Telephone: (209)468-3420 Fax. (209) 464-0136 Web: www.sjgov.org/ehd <br /> I ENVIRONMENTAL HEALTH r <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: l q x )6o 13USINESSIAGEhICY: fm <br /> ADDRESS: fr CITY/STATEIZIP: <br /> PHONE(4): lQ l^.�q ��lq �y PHONE(2): FACSIMILE: 1_ <br /> TENrAT[VE=APPOINTMENT DATE; Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be conflrmod) <br /> CHECK BOX TO ExPPDIYE REO T-$125 FE ( SH OR CHECK ONLY)-REQUI=ST PROCESSED IN 3 6 SIN SS DAYS <br /> SIX <br /> I NAT RE OF APPLICANT DATE <br /> Electronic Information: �4 List C Map—Description: ' - <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Streat Name <br /> City ❑Unit i <br /> �. ►�/r- <br /> z <br /> ❑Unit 2 <br /> 3. r w <br /> 4' Unit 9 <br /> 6. <br /> i ! I <br /> ly iL4 ts,Z ZUnit 4 <br /> Unit g I <br /> 9, <br /> 1i 0 Unit 6 <br /> Specific Date Range of Information Requested: From II to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑Hou51No ABATEMENT ❑SOLID WA$TI FACILITYNEHICLE. <br /> 9 OTHER CLEANUP SITE(HON-LOP) ❑FOda FACILgY ❑WASTE TIRE <br /> I UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑VAIRY <br /> HAZAREws WASTE GENERATOR E]CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED FPRMITTED FACILITY - ❑MOTELIHOTEL El�� _I-rr PUMPER TRUCt(IYARDICHEMICAL TOILETS <br /> [j❑ <br /> TATTOO/800Y PIERCING POOLISPA I_ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑,COMPLAINT RECORDS ❑OTHER(PLEASE SPECEFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY,.FRIDAY 8:00 AMI-5:a0PM ING HOLIDAYS) <br /> { 7, List up to ten addresses in the space above. Select the typa(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)404-0139 or mall to the address Indicated above. Address � <br /> ranges will not be accepted-for additional assistance with fila addresses,contact the EHD. Applications received after <br /> 3A0 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant It any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will he held for a maximum of five business days for review. Appointments.. <br /> should be scheduled accordingly. ' <br /> 3. A file that Is actively haing worked on by EHD staff may not be immediately available for review. A now application may be <br /> submitted when the filo 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 applicant. <br /> Future fife reviews by the same applicant may require a$125 deposit prior toYoview. <br /> use aN (� - QE9 <br /> 7 <br /> y <br /> EHO 4U-CO <br /> ----- <br />