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DA EHD LOG NUMBER <br /> (a_ SAN.�OAQUIN COUNTY <br /> - ENIWONMENTAL HEALTH,DEPARTMEIT <br /> AUG r.1 201f;; <br /> 600 East Main St.'Stockton, CA 95202-3029 <br /> 1Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd <br /> ENVIRONM4 NTAL HEALTH <br /> PERMIT/SER E PUBLIC RECORDS RELEASE APPLICATION <br /> ,. I <br /> APPL[CA T: G <br /> + BUSINESSIAGENCY: L/ <br /> ADDRESS- k= z2� �t0 wtv.r>. CITYISTATEIZI - <br /> PHONE (1) PHONE (Z): FACSIMILE&I I j.1.�I ' D�IJ'�? <br /> TENTATIVE*APPOINTMENT DATE: - <br /> , Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TD EXP DITE EQU T-$122 FE C SH-O CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS D YS <br /> SIGNATURE OF APPLI DATE I I <br /> Electronic Information: 1st ❑.Map— Description: <br /> 1. FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> El Unit, 1 <br /> 2. e4l) 1 �llnif 2 rl <br /> 3. .7 S <br /> 4. (� rJ� ' G� b. U6431Uj <br /> 6. <br /> r unit a <br /> 7, <br /> Lf(go <br /> $ El Unit 5 <br /> 9. <br /> 10. <br /> i nit <br /> ZNDERGROUND <br /> cific Date Range of Information Requested: From i to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES S TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT LID WASTE FAC ILITYNEHICLE <br /> ER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY NWASTE TIRE <br /> ERGROUND TANK(MON ITORINGIREMOVAL) ❑DOGKENNEL E:1 AIRY <br /> ARDOUS WASTE GENERATOR ❑CHICKEN RANCH <br /> ❑TIERED PERMITTED FACILITY AST€WATER TREATMENT PLANT. <br /> ❑MDTELIHOTELR PER TRUCKIYARDICHEMICALTOILETS <br /> ❑TATTOOIBODIf PIERCING ❑POOLISPA AND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY- ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR'REVIEW: MONDAY-FRIDAY 8:00 AM-5: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 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 apy roximately ten (10) <br /> days after'ieceipt of,application. The files will be held for a maxima n 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 riot he 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 fiereviews by the same applicant may require a$122 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4M6 a� <br /> orrzsr�a <br />