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DATE rFI E.�� <br /> R EHD LOG NUMBER <br /> C.'v SAN JOACIUIN COUNTY <br /> ENv��CONMENTAL HEALTH DEPARTMv'T <br /> MAY 31 Z011 600 East Main St. Stockton, CA 95202-3029 �a <br /> 0 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> EM/tRONNAEN�oLcHEAM PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: JtQXl1ti�� G`av1� BUSINESS/AGENCY: 40 <br /> ADDRESS: (J(� 3DB `��l( CITY/STATE/ZIP: (: n 55 1 <br /> PHONE (1): PHONE (2): 0,0T FACSIMILE: )t?5 c(.n - 3S( <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 REQUEST122 FEE(CASHQR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE l 1l <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name CilyUnit 1 <br /> 1. w S u�;(Oz) I Na W5 <br /> 2. ❑ Unit 2 II <br /> 3. �F <br /> 4• 1' Unit 3 <br /> 5. <br /> 6. .❑ Unil4 <br /> 7. <br /> 8• Unit 5 <br /> 9. <br /> 10. nit <br /> Specific Date Range of Information Requested: From LG.4L l O \/0,jL.YS -t-;h to <br /> ENVIRONMEN AL HEALTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) r����i FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> TATTOO/BODY PIERCING ❑POOLISPA ❑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:OOPM(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)464-0138 or mall 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$122 deposit prior to review. <br /> EHD USE ONLY <br /> cd A-C' <br /> EHD 48-06 <br /> 07/29/16 <br />