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";=PIED <br /> =P kv SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> E"RONMENTAL HEALTH DEPART ONT <br /> N: ^I 5 2000I9g[@p 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIRONM ENTHtNL4t( one: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.or <br /> PERMIITISERVtvF PUBLIC RECORDSRELEASEAPPLICATION <br /> 40Y <br /> APPLICANT: J BUSINESS/AGENCY: <br /> AADDRESS: CITY/STATE/ZIP: <br /> PHONE (1)• PHONE(2): t� FA &� <br /> CSIMILE. <br /> TENTATIVE*APPOINTMENT DATE: SQL OF 9- 1 Time: ? <br /> (Please allow 10 business days from date of application submittal-•Tentative only must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITEQUESS(Tn$1.15�00 F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN� DATE t I fT d <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City - [3 Unit 1 <br /> 1. <br /> 2. <br /> 2 <br /> 3. <br /> 4. i (J <br /> ❑Unit <br /> 6. <br /> ❑Untt 4 I� <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> g• veri Gh e; frlo <br /> 10. PtIfS +0 be- fet/iewe4 m A- N 4n V7 It ItoI <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY El SOLID WASTE FACILffYNEHICLE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL WASTE TIRE <br /> ❑HAZARDOUS WASTE GENERATOR DAIRY <br /> ❑CHICKEN RANCH ASTEWATER TREATMENT PLANT <br /> F1 TIERED PERMITTED FACILITY _ ❑MOTELIHOTEL PUMPER TRUCKNARDICHEMICALTOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA <br /> El LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY <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 up to ten addresses in the space above. 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 mail to the address indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <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) <br /> days after receipt of application. The files will be held for a maximum of five business days 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 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 /> EMD --ONLY <br /> ***If you need further assistance please contact Diane Martinez direct) @ (209)468-3425. Thank You*** <br /> can eana <br />