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\1e EHD LOG NUMBER <br /> t2v-'�Ge' SAN JOAQUIN COUNTY <br /> X011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E=ast Main St. Stockton, CA 95202-3029 50qq <br /> jfttj�bone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> EK <br /> R04m sS OJGES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: &571 14 BUSINESSIAGENCY: r�@✓u„n 1 <br /> ADDRESS: SAt►. C CITY/STATE/ZIP: <br /> PHONE(1): PHONE(2): FACSIMILE: (qtb� 'd13o-x(403 <br /> TENrA IVE-APPOINTMENT DATE Time' <br /> (Please allow 10 business days from date of application submittal-'Tentative only•must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-A122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 4 , k"� DATE ( �o <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street 0 Street Name City ynit 1 <br /> y }� 2. S. i,Crw(� nit 2 <br /> 3. <br /> 4. -, nit 8 <br /> 5. <br /> 6. 6Sia <br /> — , Unit 4 <br /> 7. <br /> 8. <br /> El Unit 3 <br /> 70. <br /> nit 8 <br /> Specific Date RanRa of Information Raquastsd: From Mom to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> INDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENTS ID WASTE FACILn`/NEHICLE j7 GV <br /> dHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY LTIYASTF TIRE <br /> FDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL RY 1� <br /> ARDOUS WASTE GENERATOR OC ❑CHICKEN RANCH �STEWATER TREATMENT PLANT (� <br /> TIVEREDPERmrn-EDFACILFI-Y C?I\ ❑ TEL/I-IOTEL UMPER TRUCKIYARD/CHEMICAL TOILETS <br /> El TATTOOIBODY PIERCING ,,�-,� <br /> L►11'OOLISPA ❑LAND USE APPLICATION SITES <br /> �IIEDICAL WA$TE FACILrry ❑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(209)484.0138 or mail to the address Indicated aboyg, 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 conflrmed approximately ten(10) <br /> days after receipt of application. The files will behold 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 flee 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$122 deposit prior to review. <br /> EHD U8!ONLY <br /> 4- © o- r- O <br /> ( Q <br /> 11' 0- (p a <br /> END 46-0i6 omen o <br /> l00/100�J \ XV-4 BE OL L L07,/bL/90 <br />