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EHD LOG NUMBER <br /> DATE RECEIVED AD <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL 1 EALTH DEPARTMENT <br /> • OCT 2 8 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENV'!,._ .,,,cNTALHIE" <br /> PERMITisim CFS PUBLIC RECORDS ;-:'ELEASE APPLICA 3 iOH <br /> APPLICANT:_ BUSINESS/AGENCY: <br /> ADDREi CITYISTATE/ZIP: WrSF Snrrnrnev�m 1A <br /> PHONE(1): I(D 3 a- lvl3 LI PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: i ime: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-roust be oDrfirmad) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Descripticrr. <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unic 1 <br /> 1. <br /> 2. ❑Unit2 <br /> 3. <br /> 4 at3 <br /> 5. <br /> 6. A.d Um14 y�7� <br /> 7. <br /> a. '; ❑ u,1;.5 <br /> 9. <br /> 10. <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTr1 DEPARTMENT FILES <br /> OOTHER <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL''AIASTE FACILITY ❑SOLIO WASTE FACILITYNEHICLE <br /> CLEANUP SITE(NON-LOP) ❑HOUSfNG AEATEMENT ❑161ASTE TIRE <br /> NDERGROUND TANK(MONRORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATAENT PLANT <br /> M A2 RDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHO?EL ❑PUMPER TRUCKIYARDICHEMICALTOiLETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-E;:00PM(EXCLUDIHNG HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by cracking iiia appropriate <br /> box(es). At least one file type MUST be selected. Fax to(9W 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 alter <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 appJcauor.may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released'viili be reorganized by EHD staff at the expense oftha applicant <br /> Future file reviews by the same applicant may require a£126 deposit prior to review. - 'BOXED AREA-EHD USE OICL`! <br /> • <br /> <O Records provided by Staff-PPR Complete. stnri Name: <br /> EHD 48-06 514112 <br />