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f R <br /> F KfE � y <br /> REUM <br /> � > 408 260 86 7 t 1 Mar. 2B 281 35:40AM P1 <br /> EHD LOG NUMBER <br /> DATE"RRCEIVED SAN JOAQUIN COUNTY <br /> 101 ENVIRONMENTAL HEALTH'DEPARTMENT � <br /> 600 East Main St. Stockton, CA 95202-3029 1 <br /> ENVIRONMENTAL HE <br /> PERMITISERVICE phone: (209) 468-3420 Fax: (209) 464-0138 Web www.s�9ay.orgleh 1 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSWESSIAGENCY: �1 <br /> ADDRESS:. CIT YISTATEIZIP: <br /> PHONE M; 40D �7 .-_ PHONE(2)4FACSIMILE: <br /> TENTATIVE"APPOINTM NT DATE'. 'I Time: <br /> (Please allow 10 business days from data of app ication stibMittal-*Tonlative only-must'be confirmed) <br /> dCHECK BOX TO EXPEDITE'REOVEsT-$122 FEE(GASH OR CHECK ONLY)-REQUEST PROCESSEd IN 3 BUSINESS DAYS <br /> SIGNATURE.OF APPLICANT DATE <br /> Electronic Information: List 0 Map-i3escriptian: <br /> FILE ADDRESS Eula USE ONLY <br /> Stroot 9 Street Name City Unit 1 <br /> z ❑unit2 �. <br /> 4. ' Unit 3 <br /> _j. �i Unit4 <br /> r7. <br /> - / <br />`. ]Unit 5 <br /> 10. Unit s <br /> Spec Date Range of Information Requested: From to <br /> sifl <br /> ENVIRONMENTAL HEAL H D P ItT T F <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT f q LID WASTE FAciLff YNEHICLE <br /> OTHER CLEANUP SITE(Nom-LOP) ❑FOOD FACILITY Q WASTE TIRE <br /> [UNDERGROUND TANK(MONITORINGIREMOYAL) 0 Doc KTNNEL E]DAIRY <br /> I` �H DOUS WASTE GENERATOR ❑CtiICKEm RANCH. El WASTEWATER TREATMENT PLANT <br /> A. IEPEI}PER1fNfTfED FACILITY ❑MOTELiHOTEI ❑PUMPER TRUCKIYARDICHEMICAL_TOILETS <br /> Q TATTOt716GDY PIERCING ❑PootlSpA LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIF=Y) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW.:MONDAY-FRIDAY 8:00 AM-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. List u ten address in the spats aF�ove:, Select the types)of fries from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(200)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 ieceived.after <br /> 3:40 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. Are appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies 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 F.HD staff may not be irrtmediately available for review. A new application may be <br /> submitted when the file is available. <br /> 1 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 roquire a$122 deposit prior to review_ <br />} <br /> EHD USE ONLY. <br />