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TO'd �f�101 �, - (Dr= DN@ER <br />DATE RECEIVEDLOG <br />SAN JOAQLJIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTME <br />304 Last Weber Avenue, P Floor, Stockton, CA 95202- )8 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www,sjgov rgin <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: I <br />ADDRESS:��t�� <br />PHONE(1�PHONE(2 <br />TENTATIVE" APPOINTMENT DATE: <br />(Please allow 10 business days from <br />(( FACSIMILE: —`'Xii, — 4 -Su <br />Time: <br />of application submittal-'Tenfafives only -must be confirmed) <br />© CHECK BOX TO EXPEDI EQ S $95.00 FEE (CAS CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE��s^ <br />UNIT DISTRIBUTION <br />� fD Unit 1 ❑ Unit 2 0 Unit ❑ Unit 5 ❑ Unit 6 O Other (electronlc/Ilsts/maps) <br />FILE ADDRESS <br />Street # Street Name City <br />EHD USE ONLY <br />.. <br />4. t �` X1'7, �I�— At Il l —6�5 .o I <br />6. <br />7. 6_ — no <br />u ,* ttl- <br />8.-- <br />9: <br />Specific Date Range of Information Requested: From � �� to <br />ENVIRONMENTAL HEALTH DEPARTMENT FIDES <br />NDEAGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT OLID WASTE FACILITY/VEHICLE <br />THER CLEANUP SITE (NON -LOP) O FOOD FACILITY ❑ WASTE TIRE <br />NDERGROUND TANK (MONITORING/REMOVAL) CI DOG KENNEL CI DAIRY <br />AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY M MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILET$ <br />❑ TATTOO/BODY PIERCING Ci POOL1$PA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ 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 <br />appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address <br />indicated above. Address ranges will not be accepted -for additional assistance with file addresses, contact <br />the EHD. Applications received after 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 <br />approximately ten (10) days 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 being worked on by EHD staff may not be immediately available for review. A new <br />application may be submitted when the file is available. <br />4. Any file not returned in the same condition as released will be reorganized by EHO staff at the expense of the <br />applicant. Future file reviews by the same applicant may require a $95.00 deposit prior to review. <br />EH6 4$-66 <br />8/1MG <br />TO/To'd L8bi= b8L 9T6 <br />3-1-II i13SOd - NODUdd31 SE : b T 2,00E -EE -slid <br />