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DATE RECEIVED EHD LOG NUMBER <br /> I — SAN—JOAWN COUNTY — _ <br /> IR ENVIRONMENTAL HEALTH DEPARTMENT F <br /> OC 1 1, 7 201? 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> `Telephone : (209) 468-3420 Fax: (209) 464-0138 Web : www. sjgov. org/ehd <br /> TFNViRONMENTALHEAITNPUBLIC RECORD <br /> RELEASE APPLICATION <br /> PFAMITISE[�VICWS i ' y <br /> 961 a rian <br /> APPLICANT- c, ciA A BUSINESSIAGENCY: <br /> ADDRESS: i0gQ � � �Fo ,• r c S } CITY/STATE/ZIP : <br /> PHONE (1 ): --1 - j �S_L _ PHONE (2): v - G �� ( _Z7o � FACSIMILE: <br /> TENTATIVE` APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal - 'Tentative only - must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ DATE <br /> Electronic Information : ❑ List ❑ Map — Description : <br /> FILE ADDRESS EHD USE ONLY <br /> Street # Street Name 1 ` City ❑ Unit 1 <br /> 2, ❑ Unit 2 <br /> 3. <br /> 5 t <br /> 6 . , �i /B fve /ot4 ' <br /> 7. <br /> 8, E] Unit 5 <br /> 9. <br /> 1D ❑ Unit <br /> JH%BOVEGROUND <br /> ic Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ERROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYNEHICLE <br /> CLEANUP SITE (NowLOP) ElHOUSING ABATEMENT E] WASTE TIRE <br /> GROUND TANK (MONITORINGIREMOVAL) F1 FOOD FACILITY ❑ DAIRY <br /> TANK ❑ CHICKEN RANCHI DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br /> RDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑ PoOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PIERCING ❑ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8 :00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br /> 1 . List un 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 (209) 464-0138 or mail 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 files 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 staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a $125 deposit prior to review. ffe0 (ED ARE+9 - EHD USE O <br /> I <br /> f <br /> Recur is provi ied by Staff-PPR Complete° staff Nan e: <br /> 914112 <br /> Fun AA.n <br /> r, <br />