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1000 <br /> eco 04010 tNM Wtbl WG Z001/001 <br /> EHD LOO NUMBER <br /> al_ C 1 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT &-7 <br /> MAP 13 2008 600 East Main Street, Stockton, CA,95202-3029 �31id ENVlR0 A'F1'IT H'EALTH Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.or <br /> F.....l-_5 //� PLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUUSIINErSSIIAGGENCY: <br /> ADDRESS'._f/-777 <br /> /I-f r1 �/ 1 � / j]��/ /y-1) U'(P�wl Y ?N3"f <br /> PHONE(1):l ;/ o( /q'�?0004r PHONE(2)ky S)�7l(/-L q65 FACSIMILE: <br /> 1�1GI!(' 120011 TENTATIVE'APPOwrMErv7 DaTE: Tlme:(Please allow 10 buetneSS days from data of appdcatlon submittal- ) <br /> CHECK BOX TO EXPEDITER UEST•598.00 FEE(CAS OR CHECK ONLY)-REQUEST PROCESSESIN� <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street9 Street Name City ❑ Unit <br /> 1. <br /> 2. ❑ VMt2 <br /> 4. UnR3 <br /> 6. <br /> T. <br /> 9 ❑ units <br /> 9. <br /> -- ❑ Unit 6 <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 FACILITY(VEMCLE <br /> O OTHER CLEANUP Sim(NON-LOP) 0 FOOo FACILrrY 17 WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 13 Dor KENNEL 11 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITIEO FACILITY 0 MOTELMOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOOIDODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 5:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the types)Of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0135 or mail to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD.Appllcatlons received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD flies exist. An appointment for review will he confirmed approximately ten(10) <br /> days after receipt of application. The flies will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A The 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 fie is available. <br /> 4. Any file nut 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$96.00 deposit prior to review. <br /> EHD USE ONLY <br /> E DABA6WEe a ?x)7 <br />