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A r. 9. 2012 2: 2 5 P No. 3556 P. 1 <br /> PATE;RECEIVED9 EHD LOG NUMBER <br /> RECEIVED <br /> y ® SAN JOAQUI ou r�► ' <br /> 1 CEI V E ENVIRONMENTAL HEALTH -A <br /> E # <br /> 600 Fast Main St. Stockton, CA 95202-3029 <br /> Telephone, (209)468-3420 Fax: (209) 464-0138 Web: vwvw.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH! <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I DUSINESAGENCY:A" I <br /> 1 <br /> ADDRESS: CITY/STATEIZIP: Ik� QCA q3� <br /> �PHONE(1): <br /> TEN7'AT'IVE=AP OINTMENT PATE; 1 Time: <br /> (Please elle 10 business days from <br /> date of application Submittal--Tentative only-must ba confirmed) <br /> CHECK BOX TO EX EDITEREQ T-$125 FE ( SH OR CHECK ONLY)-REQUI=ST PROCESSED IN 3 B SIN SS DAYS <br /> SI NAT RE OF APPLI ANT DATE <br /> Electronlc Information: ;9 List❑ Map—Description: <br /> FILE ADDRESS EMD USE ONLY <br /> Street# Street Name City ❑ t 1 <br /> 1. <br /> 2, <br /> Unit 2 <br /> 3. <br /> i T DtS <br /> 4, <br /> -- Unit 9 <br /> 61 W <br /> 7, <br /> a. <br /> Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Informat on Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CL NUP SITE(LOP) ❑HOUSING ABATEMENT - ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LO ) ©FOOD FACILITY ❑WASTE TIRE ESQ <br /> UNDERGROUND TANK(MONITORI GIREMOVAL)� ❑DOG KENNEL []DAIRY C, <br /> HATARDous WASTE GENERATO ❑CHICKEN RANCH <br /> ❑TIERED PEpMITTED FACILITY ❑WASTEWATER TREATMENT PLANT q <br /> ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA <br /> ❑LAND USEAPPLICATION SITES <br /> Lj MEDICAL WASTE FACILITY <br /> ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT R CORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8.00 AMI-5:00PM EXCLUDING HOLIDAYS) <br /> 1, List up to ten addresses 11 the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file ype MUST be selected. Fax to(209)464-11130 or mall to the address Indicated above Address <br /> ranges will not ba accept d-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processoc the next business day. <br /> 2. The EHD will notiFy the ap licant If any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies 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 beinE 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 th sat-no condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the nme applicant may require a$125 deposit prior to review. <br /> t USC ON t Wall <br /> U 7 1 5 r �lJ71-7AEHD 40.05 <br />