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PAGE 01 <br /> EHO LOG NUMBER <br /> SAN JOAQUINCOUNTY <br /> ERV-MONMENTAL HEALTH DEPARTMENT <br /> SEP " F r.vuo 304 East Weber Avenue, Yd Floor, Stockton,CA 95202-2708 p <br /> ENVIRtiP, 'rt IT1iEaLerlephone:(209)468-3420 Fax:(209)464-0738 Web;www.sjgov.orwchd if <br /> PERM;1r. ��, ;:ICESPUBLICRECORDS RELEASE APP)LICA'TIAON t._5 <br /> APPLICANT' �p^VbV� �� r1 aa OUSINESSlAGENCY:,i'[__„��GUnN�Aat+L�Q�"�S <br /> ADDILF_•.Mv: 2-G6V <br /> PHONE(z): 25 FAcsnwLt: j j_5 l?! <br /> TENTATIVE*APPOINTMENT DATE: Tines: <br /> (Please allow is bosimss days from date of application submimal-'r'entai"only-must bs Confirmed) <br /> © CHECK aox To ExPEDITE REQUEST-$95.00 FEE(CAS CHECK ONL.Y)-P.EQUEST PnCICES5ED IN 3@USINESa DAYS <br /> SIGNATURE OF APPLiCANT � �� l� —DATE <br /> UNITDISTRIBUnoN ❑ Unit 1 El Un1t2 0 Unit 3 ❑ Unit4 M Unlit$ 0 Units r Othar(eloe3an ofiistrJmaps) <br /> FILE ADDRESS ..o EHID USE ONLY <br /> streat0 Street Name city <br /> +~Rani- a�—k —_ <br /> 2. 3Z _Rtnf'afi L�' G <br /> 3. <br /> 4. i <br /> 6. <br /> loft i"M <br /> 7. <br /> s. SEP <br /> Specific Date Range of Information Requested:Frim to <br /> y/ ENv1RONMENTAL HEALTH DEPARTMENT FILES <br /> J��td.IIO , up TANK(UST)CLFANUPSii,(L.OPjrL ❑HOWING ABATEMENT S' D WASTE FACIL'TYNeHM_LE� <br /> OTHER CLEANUP SITE(NONd..OP)-?, ❑FOOD FACILITY LJ WASTE TIRE <br /> UNOERGRODNO TANK(MONITORINGMENCYAL)X 0 DOG KENNEL ❑DAIRY <br /> 1AZARDOUS W ASTE C='NEPqTOR.k ED CKCKEN RANCH U[ASTEWATERR TREATMENT PI.ANTY,v <br /> TEREO PERMITTED FAqury E7 AOOTELfROTEL PULS'ERTRU0KTYARV/CNE6i To'LET5 <br /> �C]TATTOW®OOY PIERCING ❑POOLISPA 0 LANG USE APPLICATION SITES <br /> '(MEDICAL WASTE FACILITY X 0 QTKER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW- MONDAY-FRIDAY 8:00 Affl5:00PM - ExCLUOING HOUDAYE. tA <br /> 1. List up to ton address€s in the space above. Select the typos)of tilos from the list above by checking the O <br /> appropriate box(es), At least one file type MUST be selected. Fax_t_a 1209)&kj:g139 ar mail to the addt�ss <br /> Indicated above. Address ranges will not be accepteG–IFUDLIditional assistance with file addresses,contact —� <br /> the EHO.Applications received after 3:00 pm will be processed the next business Gay. <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 tiles villi be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that I.-actively being norked an by EHD staff may not be Immediately available for review. A new <br /> application may be submitted when the nie Is available. <br /> 4. Any file not returned In the same candillon a:: released Will be reorganizeil by EHD staff at the expense ofthe <br /> applicant Future fife reviews by the same applicant may require a$95.00 deposit prior to review. <br /> I <br /> L—_ <br /> eNo uoc y` <br /> swro; <br />