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DATE RECEIVED _ EHD LOG NUMBER <br /> �� . SAN JOAQUIN COUNTY • <br /> �� �' EN IRONMENTAL HEALTH DEPARTMENT 41571 <br /> 01 <br /> Zp12 600 East Main St. Stockton, CA 95202-3029 <br /> . Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> E�VIPERN�1 ESEFtV CE L'��1 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:- BUSINESS/AGENCY: 661(" ( � <br /> ADDRESS: 9 �irJ.�c ('if1 SVc IdP CITY/STATE/ZIP: bA4A-11 <br /> PHONE (1): Zo 5 Y-ql-- t57tp 8 PHONE (2): 20 f 637-7.10 y FACSIMILE: Zsq 4;5- na L- <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 $125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 'f?A. (7 <br /> Electronic Information: ❑ List ❑ Map- Description: <br /> FILE ADDRESS__ EHD USE ONLY <br /> ``��LLS<<tr''eet# Street <br /> tName <br /> ,p, City <br /> 1. 'D�qo �-f'I It.Y S'f�ic.�'1 _ �A'V' `ti4GIt . ❑ Unit 1 <br /> 2. <br /> Unit 2 <br /> 3. ) hvx <br /> - /J <br /> 4. (4 y6 I -dUnit3 <br /> 5. ***PLEASE RESPOND AS SOON AS POSSIBLE. /I <br /> 6. I NEED TO NOTIFY APPLICANT DURING <br /> WEEK OF 5/14/12 IF EIID HAS FILES F�R� nit 4 <br /> T LISTED ADDRESSES OR NOT. ""(� <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. Gf �� 1� ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Rrr��11--UNDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT ❑SOLID WASTE FACILrrYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> L,4-UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> aHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> [TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑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 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$125 deposit prior to review. <br /> 5 o4a4 7NL <br /> Cop 'A n <br /> EHD 46-O6 /� <br /> 611/11 <br />