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• <br />DATERECE`I SAID JOAQUIN COUNTY <br />&MRONMENTaLHEALTIJ ENVIRONMENTAL HEALTH DEPARTMENT <br />PERMIT/SERVICES 600 East Main St. Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sJ9ov.or/ehd <br />APPLICANT: <br />PUBLIC RECORDS RELEASE APPLICATION <br />ADDRESS: JZL5S <br />EHD LOG NUMBER <br />INESSIAGENCY: E-fVC01,j <br />CITYISTATEIZIP: 1`55 f—lnlo <br />PHONE(l): 213- -r SS PHONE (2):1 I-ACSIMILE: �r -38v c�s�S <br />TENT.ATIVe*APPOINTMENT DATE: Time: <br />(Pwasa allow 10 business days from date of appElcatlon submttlsl - •Te�tafiva only- Must bo confirmed) <br />[:]CHECK BOX TO EXPEDITE REQUEST - $1 (C S H NLY) - FEQUEST PROCESSED IN 3 BI-1p1NES DAYS <br />SIGNATURE OF APPLICANT - - -- GATE 3 r� <br />f=Ian+rnnir- InfnrmatiOn' I-1 List n Map — Isfescription: <br />SpeciflC Data Range ofInformation Requested. From <br />HEALTH D PARTMENT FILES — G <br />NpERG1tOUNP TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT [] SOLIDWAST WASTE FACILrfYMEHICLE <br />THER QLEANUP SITE (NoN-LOP) ❑ FOVP FACILITY ❑WASTE TIRE <br />NDERGROUNO TANK (MON ITORINGIREMOVAI-) ❑ Dm KENNEL © DAIRY f (� =I <br />AZARDOUSWASTE GE=NERATOR CI CHICKEN RANCH <br />❑ <br />WASTEWATER TREATMENT PLANT L1 1LEi5 z <br />❑ TIERED PERMITTED FACILITY ❑ MOTEIIHOTEL ❑ PUMPERTRUCKIYARD/CHEMICA 4 <br />❑ TATTOO[SODY PIERCING ❑ POWSPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RE=CORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 6.00 A1VE-5:00PUI (EXCLUDING HOLIDAYS) <br />1, List up to ten addresses in the space above, Select the type(*) of files From the list above by checking the appropriate <br />box(es). At least one fife type MUST be selected. Fax to (209) 4014k:013 jjLtqjbq.Lddress indicated above. Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after <br />3:00 pm will be processed the next business day. <br />2. The EHD will notify the applicant if any EHD files exist. An appointmentfor review will be confirmed approximately ten (10) <br />days after receipt of application. The files wllf be held for a maximum of five business days for review. Appointments <br />should be scheduled accordingly. <br />3, A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br />submitted when the file is available. <br />4. Any file not returned in the same condition a$ released will be reorganized by EHD staff at the expense of the applicant. <br />Future filo reviews by the same applicant may require a $122 deposit prior to review. <br />-Z-17 . <br />aHo ae- i; <br />�_ �z . � # c�� r � Q �(is r ►� ��7 Fi fie. r fob 77 9q. <br />