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C <br /> u SAN JOAQUIN COUNT'S!' EHD LOG NUMBER <br /> ENVIRONMENTAL RIEALTH DEPARTMENT <br /> U f ti. 2 05 304 East Weber Avenue,3'a Floor, Stockton,CA 95202-2708 5 <br /> ENVIROJ�%,^,,E VT HEWKTelephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/chd <br /> PEP;14'I /SERVICES PUBLIC RECORDS RELEASE APPLICATION �p� �.,Tr� <br /> APPLICANT: MAR—i,r,t11G lw nrL�1� BUSINESS/AGENCY: Qmmkiwl - l.x�N�SUL,'T'rtt��•-a <br /> ADDRESS; i/,, WWs S I2 <br /> PHONE(1): 970-L&3 b3C PH NE(2):;?P4—n—1P7 5 ` CSIMILE: <br /> V <br /> TENTATIVE*APPOINTMENT DATE: aAM ti1G���� Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> E3 CHECK BOX TO EXPEDITE REQU T-$93.00 FEE(CAS"R CHECK ONLY)+REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑Unit 1 13 Unit 2 13 Unit 3 O Unit 4 ❑Unit 5 13 Unit 6 O Other(electronielilstslmaps). <br /> FILE ADDRESS EHD USE ONLY <br /> street 0 Stract Nano city <br /> ® 3. Pic (, <br /> 0 4. GJ-Hti SJ <br /> 5. � <br /> 7. <br /> s. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> yam,.UNDERGROUND TANK(UST)CLEANUP SrcE(LOP) E3 HOUstme AimTENENT ®SOLID WASTE FAGLrrY/VEHicl.a <br /> J�.OTHER CLEANUP SITE(Nom4-op) ❑Foob FACILITY 0 WASTE TIRE <br /> X UNDERGROUND TANK(MONFmFuNG/REMOVAL) ❑DOG KENNEL In DAIRY <br /> .LHAZARDOUs WASTE GENERATOR a CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ®TIERED PERMITTED FACILITY 0 MOTELIHOTEL ®PUMPER TRUCK/YARD/CHEM TO&ETE <br /> 0 TATTOOIBODY PIERCING ❑POOL/SPA C3 LAND UsE APPuCAnoN SITES <br /> O MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE POR REVIEW- MONDAY-FRIDAY 6:00 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(209146"138 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 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 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 some 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 /> 01l <br /> EHD 4842400 <br /> �nMoS <br /> Z00(2j (INV'INVO XI21LVR03D Ti;TV C99 OTS XV3 90:fT .LVS 20/6T/TT <br />