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GATE F� __— _, -- V10 . 0� Din V <br /> 41 E[)) SAN JOAQUIN COUNTY <br /> ��� ENVIRONMENTAL 14F.ALTH DEPARTMENT <br /> JUN; - '7 2��5 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 "07 <br /> �V <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd ji � �v/J <br /> Ebb RMi/SNR ICESTH PUBLIC RECORDS RELEASE APPLICATION <br /> 1 <br /> APPLICANT: r-y):�. 1, ( r� BUSINESSIAGENCY! . eNcSA _ <br /> ADDRESS. ICY-\1\ C)W. `sao� � 'ck 9--a;R <br /> PHONE(1): _ GI(D _Q15b yLoQ-21 PHONE(2): 9KV -11= FACSIMILF: 41la &Oa 8100 <br /> TENTATIVE"APPOINTMENT DATE: 10 Time: <br /> (Please allow 10 business days from date of application submittal-"Tenrative only-must be co ._;'- ,I <br /> CHECK BOX TO FXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED"N <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ 1 Un 3 7Umt4 0 Unit 5 Unit 6 ❑ Other(electroniUlistslmaps) <br /> _ FILE A RESS EHD USE ONLY <br /> Stn:etN Street City <br /> 2. b " a Usr V-) <br /> 3. l t� Niue— a --._ W <br /> 4. _Lx)tN`Se_01 _. L6 <br /> 5. — <br /> 7. <br /> 8. - ._. _....._ <br /> Specific Date Range of Information Requested: From 2j2nF::1 to TD _ )a ± <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 16 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT l4 SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY I WASTE TIRE <br /> qly{UNDERGROUND TANK(MONITORINGIREMOVAL) C1 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 1(.LTieREo PERMITTED FACILITY ❑MOTEUHOTEL ❑ PUMPER TRUCKIYAROICHEM TOILETS <br /> O TATTOO/BODY PIERCING 0 POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIry) <br /> WELLANOSEPTIC PERMITRECORDS ARE AVAILABLE FORREVIEW - MONDAY-FRIDAY8:00 AM-S:DOPM - 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> Indicated above. Address ranges will not be accepted-for additional assistance with file addresses, contact <br /> the EHD. Applications received after 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 <br /> approximately ten (10) days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a $93.00 deposit priorto review. <br /> EHD 042-006 mm <br /> //14+06 <br /> TOTAL P.01 <br />