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:i <br /> .. �.. <br /> RcutIVED <br /> END LOG NUMBER <br /> MAR EHD <br /> REASAN .JOAQUIN COUNTY <br /> DATE FtEC I <br /> WRONMENTALHE=ALTR ENVIRONMENTAL HEALTH DEPARTMENT <br /> PERMIT/SE~RMES 600 East Main St. Stockton, CA 95202=3029' <br /> Telephone: (209)468-3424 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> k PUBLIC RECORDS RELEASE APPLICATION <br /> d <br /> APPLICANT: � � <br /> BUSINESSIAGENCY: G� vC � ���''Tf""Js <br /> I CIIYISTATEIZIP: <br /> i ADDRESS: ILS oui 1SNiA <br /> PHONE(1): ILPHONE(2):, 'FACSIMILE: V5-380- 0501 <br /> TENTATIVE`APPOINTMENT DATE: „ Time: <br /> { (Pieasa allow 10 business days from date of appilcatlon submittet-'Tentative only-must be confirmed} <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$1 S H NLY}-,REQUEST PROCESSEQ IN 3 elf INE QAYS <br /> SIGNATURE OF APPLICANT -- DATE r� <br /> # Electronic Information: ❑List❑ Map- <br /> FILE <br /> ap-FILE ADDRESS EHD USE ONLY <br /> i <br /> Street# Street Name city .. <br /> []Unit1 <br /> - 5A'fG1C> M Uiy <br /> 2. ❑Unit2 <br /> I 3. - <br /> 4. Ak <br /> nit 3 ,,ry <br /> e CG✓ <br /> 6. Unit 4 <br /> 7. <br /> g, ❑Unit 5 <br /> 7,1 I0. O Un s <br /> F Sp"iflc Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH D PARTMENT FILES <br /> 1NDERGROUND TANK(UST)CLVANUP&TE(LOP) []HOUSING ABATEMENT ❑SOLID WASTE FACILFrY[VEHICLE <br /> THEIR CLEANUP SITE(NON-LOP) ElFOQp FACILITY E]WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAI) ❑Doc KENNEL ©DAIRY <br /> AZARDoUS WAs L G LNERAI OR ❑CHICKEN RANCH ❑WASTEWATER TREATMFNT PLANT <br /> ❑TIERED PERMrrTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMIGALTOILETS <br /> ❑TAT00180I)Y PIE1tdING ©POOOSPA ❑LANI3 Usr APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) � <br /> WELL AND SEPTIC,PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY$:.OD AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. L=ist up to ten addresses in the space above. Select the type(s)of files froathe list above by checking the appropriate <br /> box(es� At least one file type MUST be selected. Fax to f209)40k0j33 or 611;111 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 EHO will notify the applicant if any EHD flies exist. An appointment for!review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will behold for a maximum of five business days for review. Appointments <br /> Should be scheduled accordingly, <br /> ti <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 ba reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> HD uss ONLY <br /> t <br /> rzv6 <br /> 77 ` <br /> END 44-Of -' - 0712MO <br /> i - <br />