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U <br /> OE � <br /> C .�E SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> '`€1`,�` (} C9 ( 11 600 East Mair) St. Stockton, CA 95202-3029 <br /> 3 <br /> Telephone. (20'x)468-3420 f=ax: (200)464-0138 Web:vP-vw.sjgov.org/eiid <br /> Irl++l� arc r}ESM �TA(vHEALTHPUBLIC RECORDS RELEASE APPLICAT9014 <br /> 111, 1 ."ICF`:: <br /> APPLIGANY <br /> 14 .n BUSINOSIAGENDY: <br /> ADDFtES : �N_i �r7 1.f V CITY/STATE/Z <br /> IIS: Q (' �( <br /> PHONE(1): � ,-`3�6a Oc7�� PHONE(2): FACSII�I�1 11 , 0 5 <br /> TFNTATIVE"'APPOINTMENT DATE: Time: <br /> (Phase allow 10 bustness days from,dat t of application submittal-�TLnfoffve only-must foe vonfirmed) <br /> ❑CHF;rK BOX TO EXPEDITE REQUE�T '12 F E( !HYRHECK ONLY)—REQUEST PROCESSED IN 31 U INESS DAYS <br /> SIGNATURE OF APPLICANT , DATE <br /> Electronic Information: ❑ List❑ Map—Description: r <br /> FILL=ADDRIESS EHD USE ONLY <br /> Street#D Street Name city Unit 1 <br /> 5 r <br /> El unit 2 <br /> 3. <br /> 4. Unit 3 <br /> 5. - -Please respond as soon as possible. <br /> • I need to notify applicant during week of 5/14/12 if Z <br /> 7. EHD has files for listed addresses or not. <br /> 8. ❑Unit 6 <br /> 10. r Un[t G <br /> Specific naw Lunge of information Rertuasted: From to s <br /> ENVIRONMENTAL,HEALTH DEPARTMENT FILES <br /> NDERCROUND TANK(UST)CLEANUP SITE(LOP) ❑Homw ABATEMENT SOLID WASTE FACILITyNEIH1CLE <br /> THJER CLEANUP SITE(110N-SCP) ❑FOOD FACILITY WASTf=ftl <br /> NDERGROUND TANK(PIIDNITORINGIPCEMOVAL) ❑I:=KENNEL DAIRY <br /> APARDOUS WASTE GENERATOR ❑CHICKEN RANCH WA5TEWATER TREATMENT PLANT <br /> M075LIHOTEL PUMPER TRUCKIYAMICHEMICAL T OILETS <br /> E IAITTED FACILITY ❑ <br /> ITW <br /> ERED P R © _ <br /> ATTcoIBo9Y PIE em ❑POCLISPA ❑LAND U5E APPUCATION SITE5 <br /> IEDICAL WASTE FACILITY ❑WHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-I,RIDAY 8:UU AM-S:GDPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten ac res in the space above. Soiled the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected, a o 2 9 464-013 Or mall to the address lad e h v Address <br /> ranges will not be accepted.for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:44 pm will be processed the next business day. <br /> 2_ The EHD will notify the applicant If any EHD files exist. An appointmentfor reviawwill be confirmed approximately tot)(10) <br /> days after receipt of application. The files will Poe held far a maxlmtjm of five lousiness clays 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 revieve. A new applicatloh may 130 <br /> submitted when the file is available. <br /> 4. Any file not returnod in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the sama applicant may require a$122 deposit prlor to review. <br /> RyD USF ONLY <br /> ' <br /> 2 <br /> �taPns-a� orlasl�o 's <br />