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DATE RECEIVED EHD BOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> - _ f ENVIRONMENTAL HEAT,m DlEPARTMENT <br /> 600 E. Main Street, Stockton. CA 95202-3029 <br /> _. au!7 Telephone: (209)468-3420 Fax. (209)464-0138 Web:www' jgov-org/ d 9 <br /> ti'dtjip <br /> 7;= PU L C CORDS RELEASE APPLICATION <br /> APPLICANT: Q USINLSS/AGENCY: / <br /> ADDRESS. -� � V;! <br /> PHONE(1): ! ' i� PHONE(2); FACSIMILE; Q <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Please allow 1A huslness dnya from da{c of application suUndl(aTime: <br /> l-"Tentsuve only-must be co <br /> ja( CHECK BOX TO EXPEDITE REQU $95.00 FEE(CASH OR HEC ONLY)-REQUEST PROCESSED 3 5 AS <br /> SIGNATURE OF/APPLICANT DATE (� <br /> V <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name _ city ❑ Unit 1 - <br /> k-e <br /> 2- ❑ Unit 2 /) <br /> 4 _/"UnIt <br /> 5. � - <br /> -. <br /> 6• Unit 4 <br /> 7. T <br /> $. El <br /> S <br /> 10. - -- .- — - Unit <br /> -SH <br /> M.: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ADATEMENT X'WtTr <br /> D WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ Foon Fain Iry TmG <br /> NOERGROUNO TANK(MO NITORINWREMOVAL) ❑ DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMnlo FACILITY ❑MOTEL/HOTEL ❑ PUMPER TRUCK[YARDICHEM TOILETS <br /> ❑ Ar ioutuUOT PIERCING G POOLISPA 0 LAND USE AppucATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8;00 Am-&OoPM - 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 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 addrpscPs,rontact the EHD.Appllcatione recclved aftor <br /> 3:00 pm will be processed the next business day. <br /> 2. The END 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 filasx will hn held for a maximum of fiva bueinccr,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 tho flip 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 /> FHL)49-06 911312006 web <br />