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� J' EHD LOG NUMBER <br /> - �( iQ coPELED ` 0;-- SAN JOAQUIN COUNTY <br /> VIRONMENTAL HEALTH DEPARTMENT <br /> S 212 c� je.r PV1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telepho e: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> �n UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1I1 BUSINESS/AGENCY: O&Jq aAb NuCd U) <br /> ADDRESS: CITY/STATE/ZIP:am- /tel�r5337 <br /> PHONE(1): PHONE(2): _ FACSIMILE: <br /> TENTATIVE"APPO NTMENT DATE:�jpa lq/ 12 Time: <br /> (Please allow 1 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPE ITE REQUEST-$125 FEE(CASH ECK ONLY)-REQUEST PROCESSED IN <br /> 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICA T DATE <br /> Electronic Information: tZlist ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> (..w +t1, lt!), <br /> 2. <br /> ❑Unit 2 <br /> 3. <br /> 4. ' I <br /> Q Unit <br /> 5. I, <br /> 6. L <br /> ❑Unit 4 <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> [1 unit 6 <br /> Specific Date Range of Information equested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANU SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIL[IT.YIVEHIC <br /> OTHER CLEANUP SITE(NON-LOP) ®FOOD FACILITY ❑WASTE TIRE L{ 4, Ir �/ If <br /> UNDERGROUND TANK(MONITORING/ EMOVAL), -- ❑DOG KENNEL ❑DAIRY 3 <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH LA Z��Z <br /> ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY v4- ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEMicAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ©COMPLAINT RECORDS ❑OTHER(PLEASE-SPECIFY) <br /> WELL AND SEPTIC PERMIT RECO-RDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in tspace above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file typUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted r additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed thext business day. <br /> 2. The EHD will notify the applit if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of applica . The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordly. <br /> 3. A file that is actively being wed on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is avable. <br /> 4. Any file not returned in the sa condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the sal applicant may require a$125 deposit prior to review. <br /> =r.G USE ONLY <br /> tZ: <br /> g-li-It: j- `> - n <br /> EHD 48-06 ���� <br />