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✓M-c"'—"��� v �=�' '� SAN JOAQUIN COUNTY , EHD LOG NUMBER <br /> ENvIRONMENTAL HEALTH DEPARTMENT <br /> h, 15 2009gj p 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIR[ANIENThI�THL�t{hone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s1sov orPERMIT/5ER6Mq <br /> PUBLIC CORDS <br /> RELEASE APPLICATION <br /> 4 <br /> APPLICANT: 1 4 <br /> 'v <br /> ADDRESS: BU <br /> PHONE(1) SINESS/AGENCY: <br /> CITY/CITY/STATE/ZIP:Q PHONE (2): <br /> TENTATIVE*APPOINTMENT DATE: FACSIMILE. � _ <br /> ® F 9 1 C/� <br /> (Please allow 10 business days from tlate of application submdGl-'T� ive onl must be confi d) <br /> ❑CHECK BOX TO EXPEDITE QUEST-$71500 F <br /> (CASH OR CHECK <br /> SIGNATURE OF APPLICAONLY)-REQUEST PROCESSED IN USINESS DAYS <br /> N J , <br /> Electronic Information: — List� Map-Description: <br /> FILE ADDRESS <br /> Street# Street Name EHD USE ONLY <br /> 1 City <br /> - -------__. ❑unit 1 <br /> 2. - --- <br /> 3. <br /> ---._ nit <br /> 4. <br /> 5. <br /> -- -- - El- Unit 3 <br /> 6. <br /> 7. ❑Unita �a I <br /> 8. <br /> g' Vefl <br /> ch"e. Mo ❑Unit 5 <br /> 10. <br /> +D be rvv�e,.Uej MIA N <br /> Specific Date Range of Information Requested: From i I 1 I <br /> ❑Unit 6 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES to <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) <br /> E]OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT El SOLID WASTE FACILTTYNEHICLE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) El FOOD FACILITY Ej WASTE TIRE <br /> ❑HAZARDOUS WASTE GENERATOR ❑DOG KENNEL ❑DAIRY <br /> ❑TIERED PERMITTED FACILITY W <br /> ❑CHICKEN RANCH IIIfII�����-�''''�,...�..,,,,, <br /> ASTEWATER TREATMENT PLANT <br /> ElTATTOOIBODY PIERCING - ❑MOTEUHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑ MEDICAL WASTE FACILITY ❑POOUSPA El LAND USE APPLICATION SITES <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8:00 AM-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. List uo to ten addresses in the space above. Select the <br /> box(es), At least one file type MUST be selected. Fax t (2091464-0138 1 o mes from ail to he address <br /> es checking the appropriate <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applicationsbreceived after <br /> assist- <br /> 3:00 pm will be processed the next business day. Address <br /> The EHD <br /> notify the <br /> if any EHD files exist An <br /> 2 days fter rlelce pt of application. The files will be held for a maximum of five business snt for review will <br /> be confirmed days for review <br /> .q poin t e ten (10) <br /> should be scheduled accordingly. Appointments <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 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 applicant. <br /> Future file reviews by the same applicant may require a$115.00 deposit prior to review. <br /> �13 USE ONLY <br /> ***Zf ou need further assistance lease contact Diane Martinez direct) a (20968-3425. Thank You*** <br /> �4n dN Fl4 <br /> nn iMvt[ <br />