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DATE RECEIVED %, EHD LOG NUMBER <br /> (�M �[�� SAN JOAQUIN COUNTY "" <br /> I R t" CE \1 EDENVIRONMENTAL.HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor,Stockton, CA 95202-2708 <br /> JUN - �boae.(209)468-3420 Fax:(209)464.0138 Web:www.sjgov.or <br /> WAI HE ALIC RECORDS RELEASE APPLICATION <br /> APPLICANT: t� nn P 55 BUSINESS/AGENCY:I1^Q,Ri� �eN��.ft,IN�'` <br /> ADDRESS:— 22 tl M 4114!i ;o NfS'T <br /> PHONE(1)! 0-13-d- 6083 PHONE(2): L/ FACSIMILE: —79 .—!rF 19 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Piave allow 10 buslneas days from date OT application submlltal�TBn(atirD only.-must be Confirmed) <br /> CHECK BOX TO EXPEDITE REQU ST-t93 FEB(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Y-1V-� DATE 612/0�_ <br /> UNIT DiSTRIBUTroN D Unit 1 ❑ Una 2 nN 3 nh 4 ❑ Una 5 ❑ Its ❑ Other(electronlc(llstsimaps) <br /> FILE ADDRESS <br /> street Street Name CRY EHD USE ONLY <br /> C F .r3- <br /> 2. - - <br /> 3. <br /> 4. <br /> T. - . . _ <br /> LMLIJ <br /> VV <br /> Specific Date Range of Information Requested: From c_41,s to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> rrrrra��a UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 11HOUBINO ABATEMENT ''.SOLID WASTE Y <br /> FACILnNENN LE ' <br /> &l1THER CLEANUP SITE(NON-LOP) ❑FOOD FACS C3TE WASTIRE <br /> NOEROROUNo TANK(MOWtOWNWREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> 7EJ1ArARDCVS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEYYATER TR.EATYEw PLANT <br /> ❑TIERED PENMm FACILnY ❑MOTELMOTEL ❑PUMPER TRUCKfYARDICHEM TOILETS <br /> ❑TATrOOIBOOY PIERCING EPOOLISPA /p� (( ❑LAND U9E APPLIC TIONS S <br /> ❑MeacAL WASTE FacalTY a Ea(PLEASE Spco YI/1 II H0.L0.R.o(Gy S 1.JO�S;4 HGT JiT rQ.j <br /> WELL ANO SEPTIC PERMH RECOROS ARE AYMLAaLE FOR REVIEW- MONDAY,FRIDAY 9:00 Au-5:40pu - ExcwOINO Hourutys. <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(2091464-0138 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 prior to review. <br /> EHO qea� <br /> trues <br />