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SAN JOAQIJ COUNTY EHD LOG NUMBER <br /> N <br /> ENVIRONMENTAL HEALTH DEPARTMENT /✓ <br /> 304 East Weber Avenue,3'a Floor, Stockton, CA 95202-2708 <br /> EidVlhUl�e'Itl`JT yEALT�Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ebd Z f J <br /> PERNt;T;SERVI CES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ,(,�JIAa�� �7 BUSINESS/AGENCY: Qt�M/E �Y.. C.�f�.S(JLTft1T3 <br /> ADDRESS: AI I 7W7CK/,S ,S �L-�-} �y-}� II��,,�� �f���� <br /> Hen,— <br /> PHONE(1):LV-(00 ^��103� PH NE((22)):"�izin_077L5 � F CSIMILE: V /lJ -4p(03-414'f <br /> TENTATIVE"APPOINTMENT DATE: 1•~Rl - T/.lut Timer _ <br /> (Please allow 10 business days from date o}application submittal-"Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQU T-$93.00 FEE(CAS"R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE _Lg /zo s- <br /> UNIT DISTRIBUTION 0 Unit 1 0 Unit 2 0 Unit 3 0 UnR 4 0 Unit S 0 Unit(I ❑ Other(electronlrJllstsfmaps) <br /> aL <br /> Street N <br /> FILE ADDRESS EHD USE ONLY Street Nartw Cay <br /> 2. <br /> •0� 3. (o <br /> 4 ev+>ti nz 5 <br /> 6. <br /> 7. <br /> 9. <br /> 10. — <br /> Specific Date Range of Information Requested:From to <br /> �p ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Al UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑SOLID WASTE FAGLRYIVEHICLE <br /> i8[OTNERCLEANUPSfTE(NON,LOP) ❑FOOD FACILITY 0WASTE TIRE <br /> Y2 UNDEROROUNO TANK(MONnuRINOIREMOVAL) ❑DOG KENNEL ElDAIRY <br /> .kL HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH Cl WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS <br /> 0 TATTOOIBODY PIERCING 0 PUOJSPA ❑ LAND USE APPLICATION SITE$ <br /> 0 MEDICAL WASTE FACIDTY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ton 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 mall to the address <br /> Indicated above. Address ranges will not be accepted-tor additional assistance with file addresses,contact <br /> the EHD.AppllCatlons 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 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 expense of the <br /> applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> 40 <br /> END aeazeoe <br /> tnWos <br /> ZOO Q] QNV1gd0 %IiILV3t0�9 T1,TP CDD nTC vwJ OA'aT T11 _ ,__ <br />