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L!M .� 1 .� �' rrwly 1V o, 0/89 EH(P. 1 NUMBER <br />ENS CEVVE SAID JOAQUIN COUNTY <br />s�M ENVIRONMENTAL HEALTH DEPARTMENT � <br />1868 East Hazelton Avenue, Stockton, CA 9520 -62 <br />141AY 2 0 291 + Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:i v <br />PUBLIC RECORDS RELEASE APP E �. <br />n r"`✓ - <br />,APPLf�(T' /~- v DUSINESS/PGENGY:t�Etcri�f�hc�e <br />'ADDRESS: is �' CITY/STATE/ZIP:bll�t��; <br />qs- K i <br />®HONE (11: �;0- 0_1.17 -`ipy_ F-��— PHOFvE (2): Fl�Fh OR .+�r- <br />// Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />CHECK BOX TO EXPEDITE REQUEST - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF: APPLICANT DATE g— --16I (Q <br />1. List up to ten addresses in the space below. Select the type(s) of files from the list below by chocking the appropriate <br />box(es). At least one file type MUST be selected- Fat to (209) 464-0136 or mall to the address indicated above Address <br />ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. <br />2. For assistance In identifying the nature and content of EHD records, please contact EHD at the number noted above. <br />3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirrried approximately fen (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 />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 $130 deposit prior to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS <br />Electronic Information: ❑ List ❑ Map — Description: <br />. Specific pate Range of Information Requested: From to <br />ENVIRONMENTAL <br />HEALTEiDE <br />FILESRTMENT <br />FILE ADDRESS <br />e� ONLY <br />IsUNOEAGROUNOTANK (UST) <br />Street# <br />Streat'N'ame <br />city <br />IVT <br />/ <br />C� (VI .i�j11(�� <br />[] L�0113U1.'ER <br />CLEANUP C EANSITE (LSP) <br />LOP) <br />OTHER CLEANUP SITE (NON -CUB <br />WA2TE <br />����r3(IIERED PERMITTED FACILITY i <br />1 <br />2 <br />❑ DAIRY <br />�A20VEGROUNDTANK <br />UST (MONITORINQ I REMOVAL) <br />HAzAADOUS MATERLALs <br />_ <br />Q�I <br />I <br />[] PWS <br />,� <br />_ _ <br />/ o <br />SPILL/RELEAEE RECPON2E►'` <br />SOLID WASTE FACILITY / VEHICLE <br />q <br />WATER DUALITY <br />rom FACILITY <br />71 POOL / SPA <br />7011 <br />