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OT r� ED1 - EHD LOG NUMBER <br /> �IIJJU11j �L'—�IlH�E IIJI I SAN JOAQUIN COUNTY <br /> 6 9005ENVIRONMENTAL HEALTH DEPARTMEIN A <br /> - 304 East Weber Avenue, 3 d Floor, Stockton, CA• 95202-2708 <br /> ENVIRONMENT HEALTH Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> 1� 1` V � . t <br /> APPLICANT. �h r" - �' -e• lratrruc, "OL W1 BUSINESSIAGENCY: ' <br /> I � <br /> ADDRESS: p?A ( p CrOLJ Cam m PI *' Zq0 San 2aw�of a / <br /> PHONE ( l) ( ZS 666 6000 - PHONE "� � t AC SIMILE: �ZS X66019 .9 <br /> TENTATIVE" APPOINTMENT DATE: Time: w <br /> (Please ullow 1D business days from date of application submittal • "Tentative only, - must be confirm , fenpI <br /> A <br /> CHECK BOX TO EXPEDITE REQUEST • $9 FEE (CASH OR CHECK ONLY) • REQUEST PROCESSED IN s B SIN Iq(H�i <br /> SIGNATURE OF APPLICANT DATE 5 <br /> UNR. DI5TmnUTION OUnit1 GUnK2 <br /> 67 7;;;i74 ❑ Unit5 ❑ UnR6 0 Othar (elootrOniCllistslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> St(eet # Street Name city <br /> V 1 , fell �- <br /> 21 <br /> 34 - <br /> 4. <br /> 6. = - <br /> 6. - <br /> - - <br /> Ul <br /> EB. roll 11 <br /> 9' <br /> 10. <br /> 7• <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )IUNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ARATENENi ❑ $OLID WASTE FACIUNNEHK:LE <br /> 0 OTHER CLEANUP SITE (NON-LOP) 0 FOOD FACILITY 13 WASTE TIRE .w$ <br /> &-UNDERGROUNDTANK (MONITORINWREMOVAL) 0 DOG.KENNEL ❑ DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> In TIERED PERMIYrED FACILITY OMOTELIHOTEL OPUMPER TRUCKlYARdCHEM TOILETS <br /> 0 TATTOOIBODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW • MONDAY•FRIDAY 8:00 AM-5:00PN - EXCLUDING HOLIDAYS. <br /> 1 • List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the _ <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address <br /> ranges will not be accepted - for additional assistance with file addresses, contact <br /> Indicated above. Address9 p <br /> a . <br /> - ext business d <br /> the EHD. Applications received after 3:00 pm will be processed then Y <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 files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> i ' <br /> EHD 40-02400 <br /> 1111106 . <br /> TOTAL P . O: <br />