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o;-';t=, ,, ?ey :n G LOGICAL TECMICS PAGE 01/01 <br /> DATE RECEIVED 'I'r'i��l/� I 115/�f�-yV <br /> HEMMEM �AN JOAQ OUNTY EHD LOG NUMBER <br /> D ED ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAR , 2005 Tele304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 5 <br /> 9 phone: (209)468-3420 Fax; (209)464-0138 Web;WWW.sjgov.org/ehd I ( � <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION `s <br /> P APPLICANT: i/P/� ( L? <br /> ADDRESS: <br /> BUSINESS/AGENCY: <br /> / �J'��( /y f tq1 <br /> PHONE(1): Y� "/ PHONE(2): /., // <br /> TENTATIVE"APPOINTMENT DATE: FACSIMNLE: a�f ?- q 7 <br /> (Please allow 70 buslnesa tlays from date of apPllcatlon eebmlltel•' Tlme:_ <br /> Tsn"VQ only.must be Confirmed) <br /> CHECK BOX TO EXPEDITE RE EST•$9 00 F E(CASH OR CHECK ONLY)_REQUEST PROCESSED IN 1 BUSIN SS DAYS <br /> SIGNATURE OF APPLICANT f3IGd24 fJS DATE S <br /> UNIT DISTRIBUTION 0 Be-t1 ❑ Unit2 ❑ Unit2 <br /> nits 4 Units ❑ Unite 0 Olher(alectronldlietslmaps) <br /> FILE ADORES$ <br /> street R street Nee <br /> cityEHD USE ONLY <br /> 1. n <br /> 2. '� l <br /> 3. <br /> 4. <br /> 5. ��� <br /> 6. 2 <br /> 7. ...) <br /> S. <br /> 9. <br /> 10. / <br /> Specific bate Range of Information Requested:From to <br /> �,.. //�. Q\'I", ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> J�UNDERGROUND TANK[UST)CLEANUP SITE(LOP) O HOUSINGAOATEMENT dSOIID WASTE FACILDYNEHICLE <br /> -INOTHER CLEANUP SITE(NON-LOP) ❑FOODFAoUTY <br /> 17 UNDEROROUND TANK(MOMTORING/REMOVAL) 0 DOG KENNEL 0 WASTE TIRE <br /> 0 HAZARDOUS WASTE GENERATOR DAIRY <br /> 0 TIEREn PERMITTED FACILITY CHICKEN RANCH O WASTEWATER TREATMENT PUNT <br /> 0 TATTOWBODY PIERCING 0 MOTEUHOTEL 0 PUMPER TRUCK)YARDICHEM TGILETS <br /> MEDICAL WASTE FACILITY LI POOL/SPA 0 LAND USE APPLIGATION ST1E9 <br /> OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW • MONDAY-FPoDAY 8:00 AM•6:00PM - 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 mail to the address <br /> I dicat d above. Address ranges will not be accepted-for addnlonal 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 an by EHD 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 /> EHD se-oaaar <br /> tn.ros <br />