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FTr � � ��i SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ; cU10 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIHovivir_Iv; (;ET�_�q°ne; (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; s`�� e-�C�'��0�'1 BUSINESSIAGENCY: NSU fm f GRGf-fo' 'P_R� <br /> ADDRESS: CITYISTATEIZIP: 0,1'� 'T�p-7 <br /> PHONE(1): o�0°)^ �f��—T�I Qa PHONE(Z): FACSIMILE:gog —-4-7a.—'7 <br /> TENTATIVE*APPOINTMENT DATE: 9 a--7 ) I v Time: /0: o o <br /> (Please allow 10 business days from data of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST- l FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 311 y /U _ <br /> Electronic Information; ❑ List❑ Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Stroet Street Name City Unit 1 <br /> 1. Cl 4 17 UY-) <br /> 2. 3 PC)0_0A_ Unit 2 <br /> 3. <br /> 4. ❑Unit 3 n�j <br /> 6. j6lft 4 <br /> 7. <br /> 8. ❑Unit s <br /> 9. <br /> 10. ❑unit s <br /> Specific Date Range of Information Requested: From j q(p$ _ to -elm <br /> LNVIRONMENTAI-HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> ❑OTHER CLEANUP SrIE(NDN-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZAROOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILrrY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTDILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SrrEB <br /> ❑ MEDICAL WASTE FACILITY XOTHER(PLEASE SPECIFY)phA,� itg r -j-.D So�,lor <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8,00 AM-5:00m(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of fifes from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to -0138 or mail tQ 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 END 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$122 deposit prior to review. <br /> EHD UGr ONLY <br /> 07129110EHD 48-08 <br />