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EHD LOG NUMBER <br /> SAN JOAQUIN COUNT'S <br /> ENVIRONMENTAL STEALTH DEPARTMENT r <br /> uL t� L0�5 304 East Weber Avenue,3d Floor, Stockton,CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.arg/ehd Z J <br /> U f 1 <br /> EIdViROP1�1EPdj NE <br /> PERfv?I I iSERVIGESPUBLIC RECORDS RELEASE APPLICATION <br /> IL A <br /> APPLICANT: _ P lG I(.A.( Q � BUSINESSIAGENCY: QL'�MI� I1C. C'k3N�5ULT>gf�u <br /> ADDRESS; 2(0 ( (AWS S <br /> PHONE(1): tV0—10(03 _MV(03 pry NE{(-2-)�: <br /> TENTATIVE`APPOINTMENT DATE: F-6 • TLtM 10_*` Time: "1•„'�0 GLtM <br /> (Please allow 10 business days from data of application Submittal-'Tentative only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITEREQU T-$93.00 FEE(CAS"R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT O&C DATE <br /> UNYT DISTRIBUTION 0 Unit 1 ❑ Unit 2 0 Unit 3 ❑Unit 4 0 Unit 5 ❑ Unit 6 0 Other(electronlelllststmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> DIS' Street N Street Nam City <br /> 1. 5V / iai <br /> (� <br /> D� 3. cie <br /> o y,Y, n7� y <br /> 4. rV1 <br /> 5. Sr V <br /> 7. <br /> 6. <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> '6 UNDERGROUNDTANK(UST)CLEANUPSrtE(LOPI 0 HOUSING ABATEMENT ❑SOLID WASTEFAciLITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ]5f UNDERGROUND TANK(MONm1wNGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> 2i HALARDOUS WASTE GENERATOR O CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTOO/BODY PIERCING 0 PUOLISPA ❑LAND USE APPLICATION SITES <br /> 0 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 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(2091464-0138 or mall to the address <br /> Indicated above. Address ranges will not be accepted—for additional 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 flies will he 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 on 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 /> END dB-01.000 <br /> 1n Has <br /> Z00 in ONV7HVO %I2LLVN039 T6Tf V99 OTS XVd 90:tT ZVS SO/6T/TT <br />