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DAM`WSAN JOAQUIN COUNTY EHD LOG NUMBER <br /> (D EI'lliFfIRONMENTAL HEALTH DEPARTMIENT <br /> Ir, °I 5 200981@p 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIRONN10Tt,#i tphone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.or <br /> 4Mq <br /> PERMIT/S==RMES PUBLIC RECORDSRELEASEAPPLICATION <br /> APPLICANT: `, J BUSINESS/AGENCY: <br /> ADDRESS: C ^ CITY/STATE/ZIP: <br /> PHONE (1) - I✓ PHONE (2): - FACSIMILE. <br /> TENTATIVE*APPOINTMENT DATE: ©F 9 3 1Q9Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative onl -must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE �QUEST �00FCASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESryryS��DAYS <br /> SIGNATURE OF APPLICAN DATE ` � c <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City - ❑ Unitt <br /> 1. <br /> 2. <br /> Unit 2 <br /> 3. <br /> 4. <br /> ❑Unit 3 t'Y} <br /> 5. v_ <br /> S ❑Unit 4 <br /> 7. <br /> 8. <br /> ❑Unit 6 <br /> 9. veriwit lf- rnlor es <br /> 10. b-- fe-Vi evjeGl m,A- N eh'Th it 101 ❑unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCHASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY -, ElMOTEUHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA <br /> F1 MEDICAL WASTE FACILITY ❑LAND USE APPLICATION SITES <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. 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. Fax to(2091464.0138 or mail to the address indicated 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 EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (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 /> 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 file 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$115.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance Please contact Diane Martinez direct) @ (209)468-3425. Thank You*** <br /> awn AA <br />