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i <br /> .~ E L NUMBEF� <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Al'C. 0 3U 10600 Cast Main St. Stockton, CA 95202-2708 <br /> ENVIRUNMENTT��,"" (209)46&-3420 Fax: (209)X164•-0138 Web: www.sjgov.org/ehd <br /> PFRMITISl-RV C PUBLIC RECORDS RELEASE APPLICATION - <br /> APPLICANT: ~ BUSiNESSIAGENGY: F Gte67-7 <br /> I CITY/STATEIZIP: ✓cA ?�'c����/ <br /> ADDRESS: <br /> PHONE(1): Jlrn 7(4� - y ( ): /��% � FACSIMILE: <br /> -r PWONE 2 � � <br /> TENTATIVE*APPOINTMENT DATE: �`� �� Time; 1c�ft�ri <br /> (Piease avow lo bustttass days from date of appltwtlon submittal."TentaNve only must btr canflnned) <br /> ❑CHECK DOX TO EXPEDITI=REQUEST $115.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 313USINES`'DAYS �.-•' <br /> SIGNATURE OF APPLICANT GAG - DAT<w <br /> Ellet nic Information: [:1 List❑ Map—Deschption: <br /> FILE ADDRESS FHD USE ONLY <br /> Street x 31reet Name city <br /> � ❑Unit 1 <br /> / 1 J7L -- (� f ' <br /> ❑Unit 2 <br /> 3. <br /> 4. �► <br /> 5. <br /> --� --- <br /> g Unit 4 <br /> 7. <br /> $, Q Unit 6 <br /> 9. 11 <br /> (), I T ❑Unit 6 <br /> 5peciflc Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I/ U}IDFi2GR0UND TANK(UST)CLEANUP SuE(LOP) ❑HOUSING ARMEMEHT ❑SoLlo WASTE FACILrTYfYE141C1F <br /> OTHER CLEARUP&rE(NON-LOP) ❑Foov FACIUIY ❑WASTE TIRE <br /> f UNDEkGROUNO TANK(It10NRORl aRFMOVAL)^ ❑DOG KENNEL DAIRY <br /> € <br /> ARAW6M WAM GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> [] <br /> YEW PEWITTED FACILITY MOTRMQTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TATTOOI$ODY PetCING ROOLfSPA. E]LAND USE APPLICATION SITES <br /> El 'V WASTE FACILITY OTHER(PLEASE SPECIFY) <br /> a E:LL AND SEPTIC PERMIT RECORD$ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAY6) <br /> 1. L,}tl;t uo to ten adgasn§in the space above. Select the type(a)of files from tlto list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)4t34-0156 ar mal!to the atddross indicate above. Address <br /> ranges will not be alcceplied•-for additional assistance with file addresses,contact the EHp. Applications recelved after <br /> 3:00 pm will be proemod the next bustness 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. Tlw files will be hold for a maximum of five business days for review. Appointments <br /> should ba ochoduled accordingly_ <br /> 3. A file that is actively being worked an 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 riot returned in the same condition em released will be reorganized by EHD staff at the expense of the applicant. <br /> Future Nle r©viLwvs by the same applicant may require a$118.00 deposit prior to review. <br /> EHa Us6 ONLY <br /> 'If you need further assistance pl¢osa contact directly IP (209)468-3425. Thank You*** <br /> 77.7/y71 L At, y1r <br /> 1' <br /> GYn[R.fW 0.n�� <br />