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DATE,tMEE IV!Imo'[I: Jf SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> �I�ff[['']��U���� 'L� L( L'- k EMIRONMENTAL HEALTH DEPARTI*.4T <br /> j 5 21109 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIRl1NMtNTh&Trp,ne: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.or <br /> PERMIT;SERVtrvr$ PUBLIC RECORDSRELEASEAPPLICATION <br /> APPLICANT: AmJ BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: <br /> PHONE (1) ff <br /> Q PHONE (2): �2 , ,F'A_CSIMILE. <br /> TENTATIVE`APPOINTMENT DATE: S(L_ QF 9"I J I�()Time: <br /> (Please allow 10 business days from date of application submittal-•Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITEQUEST-$175 00 F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANI,� . _ DATE 11 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street If Street Name City <br /> Unit 1 <br /> 2. <br /> Unit 2 <br /> 3. <br /> 4. <br /> ❑Unit 3 fY) <br /> 5. v_ <br /> 8. <br /> ❑ Unit4 I� <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9• vert Ch 6- frro <br /> 10. File-S +DbLreVieWM rn,d- N eOYTb ttticl <br /> ❑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 FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL p DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCHn�r�'ASTEINATER TREATMENT PLANT <br /> ❑TIERED PERMITTEDFACILITY ❑MOTELIHOTEL M PUMPERTRUCKIYARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA <br /> F] MEDICAL WASTE FACILITY E]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 /> ***Ifyou need further assistance please contact Diane Martinez direct) @ (209)468-3425. Thank You*** <br /> cwn sax <br />