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i■ <br /> j■ DATE RECEIVED EHD LOG NUMBER <br /> ■ SAN JOAQUIN COUNTY <br /> Io■ RE(C'NEWED ENVIRONMENTAL HEALTH DEPARTMENT ' <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> MAR 2 6 Z014Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> lrnluc�eNT� H�-TM PUBLIC RECORDS RELEASE APPLICATION <br /> �•pp"EE.gpgM.1SEW1; <br /> AP T:JOEL C.rADINCT BUSINESS/AGENCY: INg J <br /> ADDRESS: 217I `7%IIL.UIIsfTR— ME CITYISTATEIZIP:I`(iN Is, CA 93617, <br /> PHONE (*'5SQ.6S"7X7'2S PHONE 2): FACSIMILE: _ i-919" <br /> TENTATIVE`APPOINTMENT DATE: folfil.4 Time: =00 My <br /> (Please allow 10 business days from da a of application submittal,"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO ECPEDM REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 SU (NESS D YS <br /> 01 <br /> SIGNATURE OF APPLICANT DATE J <br /> Electronic information: ❑ Llst❑Map–Description: <br /> FILE ADDRESS _ EHD USE ONLY <br /> Street# Street Name city ❑ it 1 <br /> 2. ' GO/ P U 2 , <br /> 3, y V � Iy H ) T i D <br /> 4. <br /> Unita <br /> 5. <br /> 6. <br /> Unit 4 <br /> 7. <br /> 8 <br /> ❑UnfS <br /> 10. it_I Vnft s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WAsTE FACILITY SOLID WASTE FACILITY EHIC /, %/-z <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT 7.WAsTETIRE 5 �'Prj '/ (MI / 7 <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)gf, ❑FOOD FACILITY ❑DAIRY pGl-9-II' <br /> ABOVEGROUND TANK..L ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> X HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEUHOTEL E]PUMPER TRUCK/YARDICHEMICALTOILETS <br /> TIERED PERMITTED FACIUTI- ❑PooUSPA ❑LAND USE APPLICATION SITES <br /> ❑TATTooIBODY PIERCING ,COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HouDAYs) <br /> 1. List up to ten addresses Ili 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(209)464-0138 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 reviewwill 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�pllcant.- <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. )' BOXED AREA-EHD USE D <br /> thj <br /> i e t7D/1I � <br /> f <br /> 0 U,n <br /> EHD 4606 / 9I4N2 <br /> RAPPivArl Timc(Mar 96. 9014 4.5RPMAn. SF57 <br />