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Feb 22 12 02:38p Andrew Lush 9EHD LOG NUMBER p.1 <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTY 16 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton. CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.crglehd �r�y <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:— nnk; 1 �414 BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATEIZIP: ;/9/1) 04A �SZ <br /> PHONE(1); 'if I PHONE(2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE:_clef Time: <br /> (Please allow 10 business days from date of application submittal- T"tad a only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST 5 FEE(CASK OR ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ®/� C� . tT" OR DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> 1 ❑unit t <br /> � tl�� % F — c/^ i J,✓ IND <br /> ❑unit 2 <br /> 3. <br /> 4. <br /> 5 Unita (� <br /> 6. <br /> 7' Unit 4 <br /> 8. <br /> g — C] Unit s <br /> 10. <br /> 21 Unit 6 <br /> Specific Date Range of Information Requested: From /y'4� L to f�t�jf,.c/� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �.���s /,;�, <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 0 SOLID WASTE FACILffY/VEHICLE k <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)I� [:1 DOG KENNEL 'M D ❑WASTE FIRE , I^I13. <br /> ERj HAZARDOUS WASTE GENERATOR �tyy ❑DAIRY I <br /> V , ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEtIHOTEL <br /> ❑TATTODIBODY PIERCING ❑POOLISPA ❑PUMPER E APPLICATION <br /> SITES AL TOILETS <br /> ❑ MEDICAL WASTE FACILITY ❑LAND (PLEASE <br /> ) <br /> ❑COMPLAINT RECORDS El OTHER(PLEASE SPEgFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uD 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 1209)4640136 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 Mil 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 rile 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 /> Lo <br /> t �2 7 S i✓1 <br /> 0 <br /> EMD4a-06 <br /> 6M/11 <br />