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DATE RECEIVED env �vv rvviwocrc <br />R� C� � O ��D <br />SAN JoAQUIN CouNTY <br />ENVIRONMENTAL HEALTH DELTMOT <br />toa�'� $ �Q05 304 East Weber Avenue, Yd Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.orglehd 763 <br />ENVIRONMENT HEALTH <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: S`T��H L=�� L���L BUSINESSIAGENCY: SEc-7 <br />ADDRESS: to -uo& t!kn y <br />PHONE (1). .2Q`3i LOS - brl!� a __ __ _ PHONE (2): <br />1462- 3519 <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - "Tentadve only - must be confirmed) <br />❑ CHECK BOX To EXPEDITE RE EST - $93.00 FEEjC.ASH�OR CHECK ONLY) —REQUEST PROCESSED -IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT CZ `��..x DATE <br />FILE ADDRESS EHD USE ONLY <br />Specific Date Range of information Requested: From <br />M. <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES �t <br />fli UNDERGROUND TANK (UST) CLEANUP SITE (LOP) HOUSING ABATEMENT XrSOLID WASTE F <br />L� <br />00= CLEANUP SITE (NON -LOP) FOOD FACILITYjZrWASTE TIRE 0! 16 <br />UGROUND TANK (MONITORINGiREMOVAL) � DOG KENNEL io DAIRY <br />HAZARDOUS WASTE GENERATOR WCHK:KEN RANCH O WASTEWATER TREATMENT PLANT <br />TIERED PERMnTED FACILITY j rM6TEL1HOTEL RrPUMPER TRUCWYARDICHEM TOILETS <br />�TATTOo/BODY PIERCING XPOOL/SPA XLAND USE APPLICATION SITES <br />!ar MEDICAL. WASTE FACILITY ,/OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERLuT RECORDS ARE AVAILABLE POR REy1Ew - MoNDAY-FRIDAY 8:00 AIA-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 />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 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 depositprior to review. <br />EHo 48-02-006 <br />11/23/04 <br />M <br />