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..�" JOG O1CA'J r.r�i�Gl <br /> L� <br /> FE10 <br /> EN SAN JOAQUIN�COUNTY ONMENTAL FALTH DEPA RTNI t'T <br /> ►r 7005Telephone: <br /> East Weber Avenue,Yd Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd wool <br /> Et�P RMIT%SE,R ENT �LTH PUBLIC RECORDS RELEASE APPLICATION <br /> CE, <br /> APPLICANT: e e BUSINESS/AGENCY:. <br /> ADDRESS: 11 O 5GL!(1G1C�Q t s�3 "1 <br /> PHONE(t) �.# .�{a�� N�� PHONE(2): 9&e 3faa, :jI FACSIMILE: q(tQ StnZ_8Im <br /> TENTATIVE*APPOINTMENT DATE: 15 It-65 Time: IQ Am <br /> (Please alkw 10 business days from data of application submittal-"Tentadve only-must be confirmed) <br /> ® CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ '""'� DATE C ell Jd f2 <br /> Cr As I <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit Z Unit 3 Unit 4 ® Unit Unit 6 Other(eiectronic/iist$Imaps) nG� <br /> FILE ADDRESS EHD USE ONLY ! , 11 <br /> w. Street# Street Name City <br /> 2. p 1A <br /> 3. it <br /> `4, <br /> 5. <br /> 6. <br /> 8. - - <br /> 9. <br /> Specific Date Range of Information Requested; From xs to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILM <br /> ad UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ld SOLID WASTE FACa-I VEHICLE <br /> 15 OTHER CLEANUP SITE(NON-LOP) ❑FOOo FACILITY 151 WASTE TIRE%,UNDERGROUND,TANK(MONROMG/Ra movAL) ❑DOG KENNEL ❑DAIRY t/ <br /> VWARoous WASTE GENERATOR 11 CHICKEN RANCH ❑WASTEWATER TRF.ATMENT PLANT <br /> ERIP PERMITTED FACILITY ©MOTEI.IHOTEL ❑PUMPER TRUCKIYARDICHem Tot"T5 <br /> ®TATTOOfS0DY PIERCING 0 POOLISPA Q LAND USE APPLICATION SITES <br /> ❑MEDKIAL WASTE FACILITY ❑OTHER(PLEASE SP€CIKY) <br /> WELL AND SEPTIC PERMIT RECORPS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-8:00ww - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to-(2091464-0138 or mail to the address <br /> Indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EI4D staff may not be immediately available for review. A new <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> END"AMS <br /> 1%4x06 <br /> TOTAL P.01 <br />