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��'�� END LOG NUMBER„r' J SAN JOAQMN COUNITX <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3d Floor, Stockton, CA 95202-2708 1007 5 <br /> �I�VIhUI�I`;1'It�'S I �E�LT�4Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> Low- <br /> I,GF�,.�+,1�;5FZV�IC{/ /S�� PUBLIC RECORDS RELEASE APPLICATION `/ <br /> APPLICANT: //t /~21 G (wp BUSINESS/AGENCY: QW��a 7_ (2DWULrAP7U <br /> ADDRESS: 2lo ( w6&S S+. <br /> 7 -�J 2 <br /> PHONE(1): �V0_7[0(03 ��103 PH NE(�2) T '" �7 "��_J�O ('CSIMILE. SM <br /> TENTATIVE"APPOINTMENT DATE: lg41% Time: O <br /> (Please allow 10 business days from data of application submittal-;Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQU T-$93.00 FEE(CAS"R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Unit 3 ❑Unit 4 ❑Unit 5 ❑ Unit 6 ❑ Other(electronic/llsts/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> DI Street 0 Street Nama City <br /> 2. <br /> "a 7.x n J <br /> 4. loon <br /> _ <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> XOTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> )I UNDERORoUNO TANK(MO NrrORING/REMOVAL) ❑DOG KENNEL ❑ DAIRY <br /> ftt HAYARDOUS WASTE GENERATOR Cl CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> FJ TATToOBoDY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMn'RECORDS ARE AVAILABLE FOR REVIEW - MONOAY-FRIDAY 8:00 AM-5:00PM . EXCLUDING 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 <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—for additional assistance with file addresses,contact <br /> the EHD.Applications 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 END 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 /> �v1.! <br /> I k_r�` <br /> EHo 49-02-006 <br /> 1/1"s <br /> zoo[n Qhs IxT0 TI2ILFhI0d9 TfTf C99 OTS TFd 90:I-T .LFS SO/6T/TT <br />