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DCJ)Aff QED 1I �r� <br /> ,"; <br /> l SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL REALM DEPARTMENT <br /> M1 0 5 N07 304 East Weber Avenue, 3dFloor, Stockton, CA 95202-2708 <br /> ENVIP0J\1l0Ei'dT HEALTITelephone: (209)468-3420 Fax: (209)464-0138 Web: wwwsjgov.org/ehd <br /> PERM11*/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: t,ULt>UI=o Sit ►}{LWi/� BUSINESS/AGENCY: <br /> ADDRESS: Mn) ✓\ C- S 3 S <br /> PHONE(1):_(C� 1 1 4 _2 311 PHONE(2): FACSIMILE• <br /> TENTATIVE*APPOINTMENT DATE: Time: GvV/'r <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE - ( <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> ❑ Unit 1 <br /> 1. i 1 6n S YVIA 1 rJ ST���� M/tt•J't�� i <i t��� <br /> 2. <br /> ❑ Unit 2 <br /> 3. <br /> 4. ( i r,, D D eunit 3 <br /> 5. <br /> 6• ^�I ZOOT —7Unit 4 \ <br /> 7. HI`1 <br /> g. ❑ Unit 5 <br /> L190 = <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested:From to ` <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES . <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT O SOLID WASTE FACILIAEHICLE <br /> OTHER CLEANUP SITE{NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> (SI UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY VVV <br /> HAZARDOUS WASTE GENERATOR 11 CHICKEN RANCH 11 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 17 MOTEUHOTEL 17 PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING ❑POOL/SPA ❑ LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REv1Ew - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> I. Ust up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address 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 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 /> 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 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br />