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CJI r� r- r�Rr�� �, EHD LOG NUMBER <br /> FIR)I IRE ' _ SAN JOAQUIN COUNTY <br /> a — 7005 304 ENVIRONMENTAL HEALTH DEPARTMEN <br /> East Weber Avenue,3'd Floor,Stockton,CA-95202-2708 <br /> ENVIRONMENT HEALTH Tclephoae: (209)468-3420 Fax: (209)464-0138 Web:www.%jgov.org/cbd <br /> PE9MIMSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT aCWI BUSINESSIAGENCY: " _M <br /> ADDRESS: ry7,010 Crow Cat lym 1 p1 117-izo JPL ea*v oP� /`--rl f:.r <br /> PHONE(1):q2S 066 69900 PHONE(2): "� ` L ACSIMILE:gZ.ri66O(9� <br /> TENTATIVE'APPOINTMENT DATE: CLpfTime: w <br /> (Please allow 10 buainess days from date of application submittal.-Tentative only-must be confirm &�e,��!+ <br /> to CHECK BOX TO EXPEDITE REQUEST-39 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 SIN Alit_ <br /> SIGNATURE OF APPLICANT DATE 5 <br /> UNIT DISTRIBUTION 13 Unit 0Unit 2 ZUnit3 ClUnK4 0Unit5 M Unit ❑ Other(eleetroniollistalmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> \ .J Street• Street NameCh <br /> 3. <br /> 4. - <br /> 5. <br /> 7. Ul <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ARATENENT CI SOLID WASTE FACILITYNEHICLE <br /> 0 OTHER CLEANUP arM(NON-LOP) C1 FOOD FACILITY 0 WASTE TIRE <br /> Q DOG KENNEL 0 DAIRY <br /> le—UNDERGROUND <br /> GkNERATfUNWREMOVAL) 0CHICKEN RANCH El WASTEWATER TREATMENT PLANT <br /> ❑HAWIDOUS WASTE GENERATOR E3 MOTSUHOTEL O PUMPER TRUCKTYANDICHaM TOILETS <br /> In TIERED PERMITTED FACILITY ❑pOplJ$PA 0 LAND USE APPLICATION SITES <br /> O TATTOOIBOOY PIERCING 0 OTHER(PLEASE SPECIFY <br /> 0 MEDICAL WASTE FACILITY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 Ne•S:OOI+N E%CLUDING 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 /> lndicated 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 prior to review. <br /> EHD"A)*6 <br /> 111496 <br /> TOTAL P.O: <br />