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VED EHD LOG NUMBER <br /> r+ v SAN JOAQUIN COUNTY ..i <br /> PjOV Y. 276 ENVIRONMENTAL HEALTH DEPARTMENT 815100 <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> ENVIRt2N,MENTAL HEALTH Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: E. �- BUSINESS/AGENCY: r�WW jC AC <br /> ADDRESS: I) CITYISTATErZIP:25p' VAiI M <br /> PHONE(1): ' k PHONE(2): FAX OR E-MAIL:tJJirAd'CZXi3wxn T C- <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EX REQUES 5 F E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINE S DAYS <br /> SIGNATURE OF APPLICA DATE -Lr>I t. ` <br /> 1. List up to ten addresse In the space belpV. Select the typ (g N f flies from the list below by checking theappropriate <br /> box(es). At least one file type MUST be selected. Fax to 20 0138 or mail to the address Indicated above, Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in Identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. The,EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT REC DS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: List ap—Description: _ 7i 5,74 V'Lt <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL L/ u g-f <br /> HEALTH DEPARTMENT FILE ADDRESSRLES EHD USE ONLY <br /> xDERCRGuxD TANK(UST) Street S Street Name City <br /> /CLEANUP SUE(LOP) /^w'/I �y���/� / . ❑LLWEYYEA <br /> P OTIfER CLEANUP SUE(Nm.LOP) <br /> Lr—VI-Ar/ <br /> AUROOUS WAETE <br /> M4 EREO PERMITTED FACEITV Z i (11 r,11 G..I co <br /> n CI CAN, <br /> $rP.111R101U1AE' <br /> /1GOYECROUNa TANK 4� ( tT�/�fV L h t !„' I`� �; iVo 'V�U/ I "V I Z <br /> NORU -LEOV ❑PWS <br /> MENNLSS' RESPONSE � �yl Lt�r _ - <br /> Sd5..WASTEFAGLHY/VENICLE /-�/L �5 WATER Du4rtv <br /> A t1{JI r!(-^ r <br /> FOOD FACILITY (0 y <br /> POOL/SPA <br /> �)YUSE APPLICATION SITES S L/ t11V1Lf G(l/r 1 �• 'VhD 1,�7` <br /> ///EPTIC PUMPER TRUCK/ [3 H. <br /> .ARO/CHEMICAL TOILETS <br /> /VE — <br /> WASTEWATER TREATMENT PUNT <br /> CUPA <br /> rlHOUSINO ABATEMENT T ff <br /> ❑MOTEVHOTEL <br /> ❑CHICKEN PUNCH/DOG KENNEL COPA-MST <br /> E]MEDS L WASTE FACH" X <br /> E]TATT001BOOY PIERCING <br /> F]WASTE TRE fifSLUDIMASTE <br /> rl DONPIAINT 9 <br /> OMER(PLEASE SPECIFY): ❑A�UxRx6 <br /> 10 <br /> —BOXED AREA-EHD USE ONLY-^ <br /> z-�o eI io )• S le I z7 <br /> 60t- <br /> ❑Records provided by Staff-PPR Complete. st.H Name: <br /> EHD 4N-0S <br />