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14/16/ZUU6 lb:1U PAX <br /> U001/001 <br /> DATE RECEIVED tv 49 <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> r ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, <br /> ? L � 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) q64-0138 Web: www.sjgovRA�0 / <br /> 73 <br /> J <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> L pAPPLtCANY i,�orwn �1/' <br /> BUSINESS/AGENCY: 1Jrn./tpr <br /> ADDRESS SO &emon� S/ ZU'�F/oo City/State/Zip lArlr�o <br /> PHONE II): (SVJ) S91-772 'SCer C/I 9Y(0-5"PHONE(2): �Y/S)S9/-7500 FACSIMILE: (Y1.019/ -7S/Q <br /> TENTATIVE'APPOINTMENT DATE: <br /> (Please allow 10 business days from date of a 0wtlon submittal-'T Time: <br /> PP entaiive only-must he confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST•$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Electronic Information: ❑ Llst❑ Map-Description: <br /> FILE ADDRESS EWD USE ONLY <br /> Street# Street Name City <br /> 1• 5 00 CJes� Clu�c� e/ [IUnIt1 <br /> 2. <br /> S1acE/an UL OE " <br /> 3. <br /> ❑ Unit 2 <br /> 4. <br /> Unit 3 <br /> 5. <br /> 8' — - unit4 <br /> 7. <br /> 8' ❑ Unit 5 \ <br /> 9. <br /> 10. ❑ Unit6 <br /> Specific Date Range of Information Requested:From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(VST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> (}THER CLEANUP SITE NON-LOP000 M SOLID WASTE FACILITYIVEHICLE 2 <br /> >1/ ) 17 UNDERGROUND TANK(MONITORING/REMOVALDOG KENNFAcIELTM O WASTE TRE l J <br /> IiAZARDOUS WASTE GENERATOR Z�\ ElC]CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑MOTEUHOTEL <br /> THER( <br /> rl TATTOO/BODY PIERCING PLEASE SPECIFY) PUMPER TRUCI!/YARD/CHEM TOILETS <br /> MEDICAL WASTE FACILITY 0 OTHER(O OA 11LAND USE APPLICATION SITES <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW <br /> MONDAY-FRIDAY B:OD AM-$:OOPM - E}CLUDING HOLIDAYS. <br /> 1. List up to to 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 above. Address <br /> 3:00 pm will be processed the <br /> ranges will not be accepted—for adtlitional assistance with file addresses,contact the END. Applications received after <br /> next business day. <br /> 2. The END will notify the applicant if any END files exist. An appointment for review will be confirmed 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 END 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 END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> END USE ONLY <br /> 'Q III <br /> E[1101!4806 /04lDB <br /> PUBLIC RECORDS RELEASE APP FORM <br />