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TO'cd -1d101 [SEC GIVE SAN JOAQUIN COUNTY tHD LOG NUMBER rl ENVIRONMENTAL HEALTH DEPARTMENT GO 600 East Main St. Stockton, CA 95202-3029 5q q DEC 13 2010 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd LHE'�!� PUBLIC RECORDS RELEASE APPLICATION ENVMQUIAEQPEAPPLICAN?: !"`I�C.� � h V� BUSINESS/AGENCY: >��rb ADDRESS: ILA.. I&#J CITY/STATE/ZIP: k PHONE (1): PHONE(2): FACSIMILE: TENTATIVE`APPOINTMENT DATE: 19 Time: (Please allow 10 business days from date f appli tion submittal-'Tentative only-must be C rmed) ❑CHECK BOX TO EXPEDITE REQU - 1" HAR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAY$ SIGNATURE OF APPLICANT DATE l Electronic Information: ❑ List❑ Map-Description: FILE ADDRESS EHD USE ONLY Street# Street Name i City2. t L]Unit 2 3, 4. ----._. ..-- — unit 3 12�21 21-' 6. ,RUnit 4 7. 8. ❑Unit 5 9. 10. Un)t 8 Specific Data Range of information Requestad: From (q 5 to a ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE 3 I' UNDERGROUND TANK(MONITORING/REMOVAL)4 ❑DOG KENNEL ❑DAIRY j Z' 20-ID HAZARDOUS WASTE GENERATOPC< ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT TIERED PERMITTED FACILITY ❑MOTELMOTEL ❑PUMPER TRUCKNARD/CHEMICAL TOILETS ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•5:OOPM(EXCLUDING HOLIDAYS) 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately ten(10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$122 deposit prior to review. EHD USE ONLY --r n+ A (XI II EHD 48-06 07129H0 TO/TO'd SVSG 89E BTS T 0NI `is3m odond 8T:2T BTOE-2T-OdQ