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EHD LOG NUMBER <br /> SAN JOAQM COUNTY <br /> ENVIROWENTAL HEALTH DEPARTMENT <br /> Lic-,,' 1� 30 East Weber Avenue,3d Floor, Stockton, CA 95202-2708 <br /> i-iEKT <br /> Teleph ne: (209)468-3420 Fax:(209)464-0138 Web:www.s' ov.or /ehd <br /> 2. 50'( <br /> PEFsNl'J/SF�V'CES p BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: - I ( r BUSINESS/AGENCY: <br /> j;?—(C) <br /> h l/ ¢lti( Ck�IV�SULT T3 <br /> ADDRESS: j;?—(C) i W S S /2 �y,— 1 <br /> PHONE(1): D (03 I(VaC PH NE(2): ?'^"7 O��(Q ( CSIMILE: V /V —��Q3—4 1 4J <br /> TENTATIVE"APP INTMENT DATE: - Q,,/) Time: Q <br /> (Please allow 10 uslness days from data of application Submittal-"Tentative only-must be confirmed) <br /> C1 CHECK BOX TO EXPEDI REQU T-$93.00 FEE(CAS R CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑U It 1 ❑ Unit 2 ❑ Unit 3 ❑Unit 4 ❑Unit 5 ❑ Unit 6 ❑ Other(electronielllsts/maps) <br /> ILE ADDRESS EHD USE ONLY <br /> p(� Street# 1 Straet Name City <br /> 1. P <br /> e"I- 2 p <br /> �l,tti c� 3- <br /> a. IQ20 �p <br /> s: <br /> 7. <br /> 9. <br /> 9. <br /> 10. J <br /> Specific Date Range of Informati n Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> y�-UNDFRGROUNo TANK(UST)CIEANU SITE(LOP) 11 HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> W4OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY a WASTE TIRE <br /> }�UNDERGROUND TANK(MONITORING/11 MOVAL) ❑DOG KENNEL In DAIRY <br /> .�HAIARDOUs WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY Cl MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> O TATTOO/BODY PIERCING ❑ POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FAGUTY1I ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT�ECORDs ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 3:00 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mall to the address <br /> Indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications rece ved after 3.00 pm will be processed the next business day. <br /> 2. The EHD will notify the app scant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten(10)day 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 beingorked on by EHD staff may not be immediately available for review. A new <br /> application may be submitt�d when the file is available. <br /> 4. Any file not returned In the parne condition as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future file revle s by the same applicant may require a $93.00 deposit prior to review. <br /> EH❑as42408 G 1- <br /> vi.lvs <br /> Z00(j QITVIHVO YI2LLVROH9 TfTt C99 OTS XVJ 90:fT ,LFS CO/6T/TT <br />