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v�/uo/tuuy txl d! -LZ FAX 916 985 2093 ARCADIS FOLSOM, CA <br />KMO` <br />�/ E —LD <br />SAN JOAQUIN COUNTY <br />0002/003 <br />EHD LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />FEB �' ��U� 600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgo eh <br />ENVIRONMENTtHEAU <br />PERMIT/Sr=RVICES PUBLIC RECORDS RELEASE APPLICATIO <br />APPLICANT: <br />~ — --� BUSINESS/AGENCY:�t <br />ADDRESS:\', yL i < �,' is 1 L City/State/Zipi. <br />PHONE (1): '111c, • `\ i,'S • L� t:1 x I \" PHONE (2): FACSIMILE: `'I I • <'� `; S Z t` `1 <br />TENTATIVE* APPOINTMENT DATE: )- I .` ` 1 O` 1 <br />(Please allow 10 business days from date of application submittal - *Tentative only- must be confirmed) <br />El CHECK BOX TO EXPEDITE REQUEST - $106 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />Electronic Information: List Map – Description: ............................... <br />FILE ADDRESS EHD USE ONLY <br />Street # Street Name `"" "'"' " -"` <br />City <br />2. <br />3. <br />. .... .... ------- <br />4. -- —-----—__— Unita ~� <br />6. ---- - Unit 4 <br />7. - — <br />--......-.....______--- O <br />8, Unit 5 <br />9. - — <br />10. 0 Unit 6 <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES (1ecJ �G i <br />❑ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY/VEHICLE Qy I(/ P3 <br />. 'OTHER CLEANUP SITE (NON -LOP) D FOOD FACILITY ❑ WASTE TIRE <br />D UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />HAZARDOUS WASTE GENERATOR y 1 ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />O TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPERTRUCKIYARD/CHEM TOILETS <br />D TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br />D MEDICAL WASTE FACILITY ❑ 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 $105 deposit prior to review. <br />EHD USE ONLY <br />D 48-06 <br />