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„______Q_?/18/2006 10:59 FAX Z 002/002 <br /> DATE RECEIVED EHD LOG NUMBER <br /> nD <br /> E(�E f I YE4 SAN JOAQUIN C01WrY <br /> NVIRONMENT'AL WA THPED ARTMENT <br /> JAN IEast Weber Avenue, 3`d Floor Stockton, CA 95202-2708 <br /> IQep o <br /> nne: (209)468-3420 Fax; (209)464-0138 Web:www.sjgov-org/ehd <br /> ENVIRONMENT HEALTH <br /> PFRMIT/SERVITUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Maws BUSINESSIAGENCY: � <br /> ADDRESS: CITY S�O �i STATE,� � <br /> PHONE(I �S-� �5� PHONE(2� FACSIMILE: C)(,,Z_j <br /> TENTATIVE”APPOINTMENT DATE.^Z=f 1 /b(o _ Tlme: (Z-- _ <br /> (Please allow 10 business days from date of application submittal-'rentayve only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE( 5H OR CHECK ONLY)-REQUEST PROCESSED IN 9 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE I <br /> Electronic <br /> Information [7 Llet 13 Map-Descr(ptlon <br /> FILE ADDRESS EHD USE ONLY' <br /> Street Street Name city <br /> 1• ei D Unit 1 <br /> 2• L J <br /> 3. ti I co S .' Unit 2 qS <br /> 5 Unit 3 <br /> s. <br /> 7. Unit 4 <br /> 8. <br /> 9. El Unit 5 <br /> 10. Unit 6 <br /> Specific Date Range of Information Raqueated:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tSf UNDERGROUND TANK(UST)CLEANUP SrTE(LOP) ❑HOUSNO ABATEMENT SOLD WASTE FACILrrYNEJUCIE <br /> hOTHER CLEANUP SITE(NON-LOP) O FOOD FAC&m ❑WASTE TIRE <br /> MUrrDERGROUND TANK(MONITORINGIREmovAL) ❑DOG KENNEL ]DAIRY <br /> Iso HAZARDOUS WASTE GENERATOR d CHICKEN RANCH AsTEwATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑PumPER TRUCWYARDJCHEMK:AL ToLcTs <br /> ❑TATTOOIBODY PIERCING 13 Pooc1SPA LAND USE APPLICATrov Srrw <br /> 13 MEDICAL WASTE FACILITY ED OTHtlR(PLEASE SPECIFY) <br /> WELL AND SEPTI PERMIT RECORDS ARE AYAILA9LE FOR REVIEW-MONDAY-FRIDAY 8:00 A ,5:OOPM - FXCf_UDW(;HOUDAYs. <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 46"138 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;Q0 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 now <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 expanse of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> END 4" <br /> lontrAo6 <br />