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Aof­ <br /> BECRVED <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY �. <br /> MAR ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> EWRpNMENT►LRphone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMITISERVICE ; '' <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ee-/n :f o BUSINESSIAGE.NCY: 43-e-6zp 4-1 <br /> ADDRESS: cS,/—,-# Z CITYISTATEIZIP: <:A LZ'-CC7� <br /> PHONE (1): PHONE (2): �a r�' FACSIMILE: cam65(,--�20S�'� <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> j/d -79 (i¢�(Please allow 10 business days from data of application submittal-*Tentative only-.must he confirmed) <br /> 4 ❑ <br /> CHECK BOX TO,EXPEDITE REQUEST-$125- SH ONLY)-REQUES OCESSED IN 3 BUSINESS DAYS <br /> .SIGNATURE OF APPLICAN DAT k_ <br /> Electronic Information: ❑ Lis Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name' City ❑ Unit 1 <br /> 2. S'� o " <br /> -� O �7S�r� ❑ Unit2 <br /> 3. <br /> 4. j D� 0f Unit 3 <br /> _ r <br /> 5. <br /> 6. ❑ Unit <br /> 7. <br /> 8• I •{ / ❑ Unit 5 <br /> 9. <br /> 10. <br /> ElUnit 6 <br /> Specific Date Range of Information Fequested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> f96NDERGROUND (UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVA!) ❑.FOOD FACILITY ❑DAIRY <br /> ❑A13OVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑.MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY El gGOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: 'MONDAY=FRIDAY 8:00 AM-S:OOPM(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 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 approkimately 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. ­BOXED AREA-EHD USE ONLY-- <br /> E1 Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 4B-OB 414112 <br />