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JAN -21-1996 1107 P.02/02 <br />DATE RECEIVED46 SAN JOAUItd COUNTY EHD LOG NUMBER <br />RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br />OCT 201a 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />0\11RONMENTALWEAUTH IITI�EF1Vl <br />-PUBLIC CORDS L APPLICATION <br />pFR1UES <br />APPLICANT: N0\0 P BUSINESS/AGENCY: A ® <br />ADDRESS: l o �a 5 °t � o.'�ic» pc . �. ! a® CITYISTATEOP: <br />PHONE (1):®.O 2'-�^1 °iyPHONE (2): FACSIMILE: <br />TENTATIVE" APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal-'Tentatnre only - must be confirmed) <br />❑ CmF-CK BOX TO EXPEDITE RE=QUEST -$125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT -e-f �» DATE ! ®/-';t- L - '- <br />Specific <br />_ <br />SpecHle Date Range of information Requested: <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />HER CLEANUP SITE (NON -LOP) <br />UNDERGROUND TANK (MONITORING/REMOVAL) <br />ABOVEGROUND TANK <br />ARDOUS WASTEIHAZARDOUS MATERIALS <br />IERED PERMITTED FACILITY <br />TATTOO BODY PIERCING <br />AL HEALTH DEPARTMENT FILES <br />MEDICAL WASTE FACILITY <br />E SOLID WASTE FACILITYNEHICLE C I I <br />HOUSING ABATEMENT <br />[ VWASTE TIRE <br />FOOD FACILITY <br />❑ DAIRY <br />CHICKEN RANCH/ DOG KENNEL <br />❑ WASTEWATER TREATMENT PLANT <br />MOTELIHOTEL <br />❑ PUMPER TRUCKIYARD/CHEMICALTOILETS <br />POOLISPA <br />❑ LAND USEAPPLICATION SITES <br />COMPLAINTIRESPONSE RECORDS <br />❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />1. Ust ue to ten addresses In the space above. Select the type(s) of files from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (20914§6-0138 or mail to the addres$ tttdlaated 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 END will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately ton (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 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 END staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $125 deposit prior to review, `SOXOD AREA - Elf 09 QNLr'* <br />i T71 Rornrriarlrnviriari.bv Afgff.PPR• raornn <br />Received Time—Oct. 2. '2013--11:46AM—No. <br />TOTAL P.02 <br />