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IJ8/1b/2n01 14:53 2133800505 ENVIRONMENTAL PAGE 01/01 <br /> RL�V� Lel D SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONNIENTAL HEALTH DEPARTNEN <br /> 2007 304 East Weber Avenue, 3rd Floor, Stockton, CA 9520 - 8� <br /> ENVIRONMENT HEALTH Telephone:(209)468-3420 Fax:(209)464-0138 Web:wwwsj r e <br /> PERP4IT/SERVICES PUBLIC RECORDS RELEASE APPLICA ON <br /> APPLICANT' )24&,> OUSINESS/AG^ENCY: CCS/\1 <br /> ADDRESS: w14-S I rCe <br /> PHONE(1): PHONE(2): r/( --ai�aj-� FACSIMILE; Z��i'^ t:7—DSOs <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date Of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST• . 0 H 0 K ONLY)•REQUEST PROCESSED IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE l S D <br /> Electronic Information:—❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name CRY ❑ Unit <br /> 1. 5 <br /> 2. <br /> S. ❑ Unit2 <br /> 4. UnR3 \� <br /> 5. A <br /> 6. VVnn4 �1 <br /> 7. <br /> g. ❑ Units <br /> 9. <br /> 70. ❑ Units <br /> Specific Date Range of Information Requested_From to <br /> ,.�y� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �wMDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING A9ATEMENT ❑SOLID WASTE FACILIWfVEHICLE <br /> O OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY WASTE TIRE <br /> 752��m.�U�N�D�E��RGROUND TANK(MONITORINGIREMOVAL) 11 DOG KENNEL ❑DAIRY <br /> "—agrSARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> C3 TIERED PERMITTED FACILITY in MOTFIMOTEL O PUMPER TRUCKIYARD/CHEM TOILETS <br /> O TATTOOIBODY PIERCING El POOL/SPA ❑LAND USE APPLICATION SITES <br /> El MEDICAL WASTE FACILITY E3 OTHER(PLEASE SPECIFYI <br /> WELL AND SEPTIC PERMS RECORDS ARE AVAILABLE FOR REVIEW• MONDAY-FRIDAY 8!00 AM-6:OoPM . EXCLDCING HOLIPAYS. <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 /> 4ox(eS). At least one file type MUST be selected. Fax to(2091464-0138 or mall to the address indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EMD.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant H 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$9s.00 deposit prior to review. <br /> EHO USE ONLY <br /> EHP lLOB en3l]0a3 <br />