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P)V" 'tig �_-Aj) EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> / <br /> 21008 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 17 BUSINESSIAGENCY: :S PC, l C_ <br /> ADDRESS: lflo F: AlZr-I &I 6JLeA0r_ City[State/Zip <br /> PHONE(I): 4AC-30 <br /> - JPHONE(2): —FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE RE T- 5 ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> '�E <br /> SIGNATURE OF APPLICANT 17/ M <br /> DATE ZZZ-Z"'169? <br /> Electronic information: KLlSt M Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. <br /> Unit I <br /> A Kms rp o4jr, ©cq No W14 <br /> 2. 1 <br /> _L 1 5' 1tj <br /> unite <br /> 3- J7 A IrLev%5 Ta�!� t'j, <AAMAig <br /> 4- 4 41"000! <br /> t-a4 1 Unit 4 <br /> nit 5 <br /> 8. <br /> 9. Ooo vy AZLA_&52Ta0"-'G ❑ Unit 6 <br /> 10. [ s T fLo V"C Z-,n W I lkk%&V I <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> WNDERGROUND TANK(UST)CLEANUP SITE(LOP) MOUSING ABATEMENT 13 SOLID WASTE FACILITYNEHICLE <br /> ;WOTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY 0 WASTE TIRE <br /> -X UNDERGROUND TANK(MONITORING./REMOVAL)D( ❑DOG KENNEL <br /> 119;HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 1:1 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 13 MOTEL/HOTEL 171 PUMPER TRUCKrYARDICHEM TOILETS <br /> C3 TATTOO/BODY PIERCING 13 POOLISPA IKLAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 Am-6:00pm - 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 f209)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 review will 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 applicant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8104108 PUBLIC RECORDS RELEASE APP FORM <br />