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ALd <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East MaIn St. Stockton, CA 95202-3029 <br /> (209)468-3420 Fav (209)464-0138 Web: www.sjgov.O <br /> F—R,WAIT/,�K V PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: oeri&n BUSINESSIAGENCY: cmyvktl�. <br /> ADDRESS: ' C cITyjsTATErZiP. <br /> %,43A w4em4_� <br /> PHONE(1); PHONE(2):( 221-' 4a — FACSIMILE:j �- 6b <br /> TENTATIVE'"APPOINTMENT DATF- Time: <br /> (Please allow 10 business days from date of appilp-ation submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQU EST�,$V;!FEE(CASH OR CHECK ON l-Y)-REQUEST PROCESSED IN 3 El SINE$$0AY$ <br /> SIGNATURE OF APPLICANT DATE 1114 .0 <br /> moctroinic information: 0 List E] Map—Description, <br /> FILE ADDRESS EHD USE ONLY <br /> Street N Street Name City Unit I- <br /> _2- 7- <br /> 3. <br /> 4 4" Mk" 0*14 <br /> 5. jLq&U <br /> 7. <br /> 9. <br /> 10. ❑units <br /> Specific Date Renee of Information Reqtjosted-_ From to <br /> ENVIRONMENTAL HEALT14 DEPARTMENT FILES <br /> UNDERGRouim TANK(UST)CLEANUP SITE(LOP) ❑HOUSINr.ABATEMENT Q SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP$rrE(NON-LOP) E]F=FAcii_T WASTE TIRE <br /> UNDERGROUND TANK(11116NITORINGIREMOVAIJ []Dor.KENNEL ❑DAIRY <br /> "AZARDOUS.WASH GENERATOR E]CHICKEN RANCH Ej WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED F.AcILFTY [j MOTELl"OTLI. El PVMPERTRU(;KfYARQjC"EMICAL TOILETS <br /> EITATToo/Booy PIERCING POOLISPA El LAND USE APPLICATION SITES <br /> D MEDICAL WASTE FA(.lLrry OTHER(PLEASE SPECIFY) - <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW. MONDAY-FRIDAY 8:00 AM-5:0012M(EXCLUDING HOLIDAYS) <br /> addresses,In the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-008 or mail to the address indicated above. Address <br /> (EXCLUDING <br /> p <br /> G <br /> appropriate HOLIDAYS) <br /> r <br /> 'DAYS <br /> above. <br /> after <br /> ranges will not be accepted-for additional assistance with file addressee,contact the EHD. Applications received r <br /> 3:OD pm will be processed the next business day. <br /> m '01 <br /> 2. The EHD 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 files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> S. A file that Is actively being worked on by EHP staff may not be Immediately available for review. A now 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 LHD staff at the expense of the applicant <br /> Future file reviews by the same applicant may require 0$122 deposit prior to review. <br /> FHO uslif ONLY <br /> EHD"46 <br /> y."oA ioj "Ws. AFrt <br />