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p � �?I �� ) EHD LOG NUMBER <br /> 2 SAN JOAQUIN COUNTY <br /> ENwRONmil,NTAL HEALTU MP.A..RTMENT <br /> 3 200 600 East Main Street, Stock.-ton, CA 95202-3029 <br /> Telephone: (`209)468-3120 Fax:(209)464-0138 Web: www.sjgov. It <br /> J <br /> ENVI Uu�Itilt(vr HEALTH <br /> SERNP,/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 BUSINESSIAGENCY: _0(�P�Q, <br /> ADDRESS: 060 n N""V <br /> PHONE(1); Q Ip pNE(2? FACSIMILE: L ( <br /> TENTATIVE*App DINTMENT DATE: <br /> Time: l <br /> (Please allow 1( business day u from data of application submittal-'Tcntative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE U6 -118.0p FE (C H OR CHECK ONLY)-REQUEST PROCESSED IN 3 USIN SS DAYS <br /> SIGNATURE OF APPLICANt �`f DATE l <br /> eo <br /> Electronic Information: List[]Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Strout# Street Name City <br /> El unit I <br /> x, <br /> Ute, F <br /> ❑ Unit 2 � <br /> 3. <br /> Unit 3 �✓ <br /> 6. Unit4 <br /> 7- <br /> 60 <br /> 8. �5 9, ❑ Unit 5 <br /> 10. q Unit 6 <br /> Specific Date Range of Infotma`on Requested;From to <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEAN P SITE(LOP) E I HOusING AnATFurNT ❑SOLID WASTE FACILITYNEHICLE <br /> �THER CLEANUP SITE(NON-LOP) M FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUNtY TANK(MONITORIN EMOVAL) 0 DOG KENNEL Q DAIRY <br /> HAZARoous WASTE GENERATOR r7 CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> 17 TIERED PERMITTED FAOPIERCING <br /> ITY d MOTEL/HOTEL PUMPER TRUCK/YAR0iCHErd TOILETS <br /> In TATToo/6pDY PIERGNtr d POoIlSaq <br /> O MEDICAL WASTE FACILITSr E3 LAND USE APPLICATION SITES <br /> n OT14ER(PLEASE SPECIFY) <br /> WELL AND SEPTTC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM_4:0DPM - 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 typ MUST be selected. Fax to(20M 484-0113?_or mail to the address indicated above. Address <br /> ranges will not be accepted for additional assistance with fife addresses,contact the EHD.Applications received after <br /> 3;00 pm will be processed th 3 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 maxim urn of-rm-business 4days-€ f-mview,-Appolntrni rntg - - <br /> -should be scheduled accords I . <br /> 3. A file that is actively being w rked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is av'i'able. <br /> 4. Any file not returned in the s me condition as released will be reorganized by EHD staff at the expense of the applicant <br /> Future file reviews by the sa a applicant may require a$98.00 deposit prior to review, <br /> EHD USE ONLY <br /> EHD�B-06 WEQ �� <br />