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DATE RECEIVED COUNTYSAN JOAQUIN EHD LOG NUMBER <br /> RECEIVED Di.,'IRONMENTAL HEALTH DEPART <br /> ME�v T <br /> 0 701" 600 East Main St. Stockton, CA 95202-3029 <br /> telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: c�- &g,,otl A - BUSINESS/AGENCY: ,.t2 v�77 C-vG�«�zni <br /> 41 <br /> ADDRESS: I � CITY/STATE/ZIP: 4(J�U/?�7 ria <br /> PHONE (1): PHONE (2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT ATE: Time: <br /> (Please allow 10 business da s from date of applications mittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUE -$125 FE (C ORE f�ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE I <br /> Electronic Information: ❑ List n Map — description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street 41 Street Name City <br /> Unit 1 <br /> 2. 0 ❑ Unit 2 <br /> 3. <br /> 4. <br /> Unit3 <br /> 5. <br /> 6. Cllg1/ a / Unit 4 <br /> 7. OC <br /> 8. <br /> El Unit 5 <br /> 9. <br /> 10. <br /> E] Unit s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> � <br /> ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> L3J.CjHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ,, GROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELMOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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 addresses, contact the EHD. Applications received after <br /> 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 approximately ten (10) <br /> days after receipt of application. The files will be held for a maximum of five business 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 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 applicant. <br /> Future file reviews by the same applicant may require a $125 deposit prior to review. <br /> EHQ USE ONLY - - <br /> EHD 48-06 <br />