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RECEIVED 0 <br /> `J SAN JOLtAQUIN COUNTY EHD 1,0G NUMBER <br /> ENVI.R.ONMENTAL HFAT,TH DIEPARTMFNT <br /> o 600 E. Main Street, Stockton, CA 952023029 <br /> �Lip Telephone: (209)468-3420 Fax: (209)464-0138 Web:www,sjgov,0rg/ d <br /> L C CORDS RELEASE APPLICATION <br /> APPLICANT: •� <br /> ENCY: / <br /> ADDRESS: 4 A2 —1# USINESSIAGI <br /> PHONE(1): /_{� / �Q PHONE(2): FACSIMILE: <br /> TENTATIVE**AAPPOINTMENT fDATE: T1�; <br /> (Pleasesallow70 hlrsincss dgye from dstc of appilc0lon suVnsivai-*TerpratllM only..must be Co r <br /> CHECK BOX To EXPEDITE REQU $95.00 FEE(CASH OR CHECjf ONLY)-REQUEST PROCESSED IN 3 BUSINESS D <br /> SIGNATURE OF APPLICANT DATE - <br /> ,17 <br /> Electronic Information: []List❑ Map--Description: <br /> FILE ADDRESS <br /> sttreet0 AHD USS ONLY <br /> F, - <br /> Street Name City <br /> ❑ Unit 1 <br /> 2. <br /> _ ❑ Unit 2 <br /> 3. - <br /> 4' <br /> 5. �1 <br /> Unit 4 ✓ <br /> 7. <br /> ❑ unit s <br /> 1®, __..._____._ ...-•--•--...._. Unit 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> \\\\FII�LLES <br /> 1. ,skr <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUslNG AGATEMENT Soun WASTE FAcILITYIVEHICLE <br /> THER CLEANUP SITE(NON-LOP) C Foch FArll TTv f4 <br /> VIIASTE T1RT: <br /> NDERGROUNO TANK(MONITOMNWREMOVAL) 0 DOG KENNET, 0 DAIRY <br /> AZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT IL Ik <br /> ERED PERMn`TED FACILITY ❑MoTET_/HOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS <br /> rVQ/0WT PIERCING ❑POOLISPA 0 LAND UsE ApPuoAnoN SITES <br /> ®MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIP1r) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILAaLE FOR REVIEW- MONDAY-FRIDAY 8:00 Am,&QOPM - ExcLuDING HOUDAYs, <br /> 1. List up to ten addresses in the space abovb. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464.0138 or mall to the address Indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addre_sApsz,r_nntact the EHD_Applications received alcor <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) 4004*0 <br /> days after receipt of application_ The filast will 13P held for a mtiximum of five bueincco daya 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 fila Is available_ <br /> 4. Any file not returned In the sante 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$95.00 deposit prior to review, <br /> EHD USE ONLY <br /> web <br /> y <br />