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�j EHD LOG NUMBER <br /> 's. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N I 600 East Main St. Stockton CA 95202-3029 <br /> jp[Mi Ione: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> �a NM�SERV�G�S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: eh BUSINESSIAGENCY: <br /> ADDRESS: -.Af. C CITY/STATE/ZIP: 4K e,,t{o r( 9 -7. <br /> PHONE(1): 10 PHONE(2): FACSIMILE: 6mti$o-o(003 <br /> TENTA IVE-APPOINTMENT DATE: Time- <br /> (Please allow 10 buslnass days from date of application submittal•`Tentative only•must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-4122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT V DATE �o <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name City nit 1 <br /> -- <br /> 1. Ln Q 5 Mo . <br /> 2. S. � � nit 2 <br /> 3. 5 3 S ? y/ <br /> D�- 4. ca,`Zs nit 8 <br /> 5. LOW <br /> ft- &I, <br /> 8. 6'&A i Unit 4 <br /> 7. <br /> EJ Unit s <br /> 3;. <br /> ErV <br /> 10. <br /> .�....__..-_._ nit B <br /> Specific Data Range of Information Raquestod: From moo to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �` <br /> ✓ NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT S ID WASTE FACILn-YNEHICLE 1-1 r1 ,y <br /> KHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY LDIIASTF TIRE � Q� fr"J' <br /> DERGROUND TANK(MOWORINGMEMOVAL)� ❑DOG KENNEL RY Lt �1A _ARDOUS WASTE GENERATOR v� ❑CHICKEN RANCH ZSTEWATER TREATMENT PLANT 't/` <br /> IILLJJYYTIERED PERMTTTEO FACILITY C? ❑, EUHOTEL rumPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑,T{ATTOO/BODY PIERCING L►90OTLISPA ❑LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILrTY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILAULE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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 appropriate <br /> box(es). At least one file type MUST be selected, 0138 or mail to thea 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 ben(10) <br /> days after receipt of application. The filer,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 EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file Is available. <br /> 4. Any flee 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 /> END USF ONLY <br /> L' 0-1 a F0 r <br /> co, <br /> -' <br /> YlA (r (o D <br /> �t4 0 <br /> END 46-06 / Id / 07129116 <br /> t00/t00o / XUA 22101. LL07,/bL/90 <br />