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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM� `T <br /> S E P t 2 Z05 304 Fast Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> ENVIROMIENT HEAT telephone:(209)468-3420 Fax: (209)464-0138 Web: www.sjgov.oroehd <br /> PERMIT/J'.iIVJGE" <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ot'i C{- C-.5 14r-V( BUSINESpSIAGENCY:. C NEsM V <br /> P- 0, <br /> CONSULT/FlJ(� <br /> ADDRESS: f6600-14:03 <br /> © �1 <br /> � 9C ] �U P-1-OGK �'A 1 S 3 0/ <br /> PHONE(1): 6-_ 6 0-f¢0.3 PHONE(2): FACSIMILE: 660- 2—"5-W <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 REQ U - 93.00 FEE R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z Z - O <br /> UNfr DISTRIBUTION jlrUnit 1 Unit 2 Unit nit 4 L Unit 6 ❑ Unit 6 0 Other(electronic/lists/maps) <br /> FILE ADDRESS END USE ONLY <br /> Street 9 Street Name City <br /> 1• 2 50 O /Y7 �C 0 L 3 5 ' <br /> 2. Iv 1 <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to _ <br /> � ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> t! UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT 0 SOLID WASTE FACQMfVEMCLE <br /> OTHER CLEANUP SITE(NON-LOP) 8?T000 FACILITY O WASTE TIRE <br /> I0 o.ERGRouNo TANK(MONITORWWREMOVAL) 13 DOG KENNEL D D RY <br /> HAZARDOUS WASTE GENERATOR E3CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACgJTY ❑MOTEUHOTEL �❑PPER TRUCKJYARDlCHEM TOILETS <br /> 0 TATTooIBoDY PIERCING 13 POOUSPA Er LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTI:PERMR RECORDS ARE AVAILABLE FOR REVIEW- MONOAY-FRIDAY 8.00 AM-5:00Pu - 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 /> Indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day.' <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 /> n <br /> V. <br /> EHD 4"2-006 <br /> 11/23!04 <br />