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SAN JOAQUIN COUNTY F�Rp LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> OUT 3 0 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-342e.Fax: (W9)4,154-0138 Web; www.sjgov.orgle <br /> ENVIRONMENT HEALTH I t t 7 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: � y �� BUSINESSfAGENCY. <br /> ADDRESS; City/Statelzip '72 _.. <br /> PHONE(I)- � � •• r� <br /> ' PHONE(2); FACSIMILE:',2e3 �`�lS <br /> TENTATIVE*APPOINTMENT DATE: /1 -3 Time:_,_dGt� <br /> (Please allow 10 business days from date of appli tion submittal-'Tsntaflve only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST- E(CASH CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE U �4 <br /> Electronic Information: E]List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 'I, � Q � '✓ [� Unit 1 <br /> 32. q a It !� ❑ Unit F2 <br /> . a rc is 11 (I <br /> r t <br /> 4, It 11 it tl It (� Unl \, \ <br /> unit <br /> ti 11 It L <br /> 8. Unit 5 <br /> � ►! It 1t +c It n a CP <br /> 9. 3 <br /> II ❑ Unit 6 <br /> a. I. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> XOTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> yI UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL; ' " C3 DAIRY <br /> N HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMrrTEI]FACILITY C1 MOTEUHOTEL ❑PUMPER TkuCKIYARD/CHEM TOILETS <br /> ❑TATTOofDoDY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> D MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAY$. <br /> 1. List up to ten addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0139 or mail to the address indlcated abo <br /> theve Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact 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 approximately ten(10) <br /> days after receipt of application. The files'will'ki'e 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$105 deposit prier to review. <br /> EHD USE ONLY <br /> * <br /> EHD aa•os eioaros <br /> PUBLIC RECORDS RELEASE:APP FORM <br />