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Uy U4',34P t,,iicrie Ualroun 9) 948-0141 P.1 <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vvww.sjgoV.or <br /> F q <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> --f U f BUSINESSIAGENCY:_ZC_ <br /> yf <br /> ADDRESS: (-,,A Lj L4 Ll--e CITYISTATE/7-IP: :5 ec,E' /7 <br /> PHONE (1): PHONE(2): *2 0 FACSIMILE: -20�FV� <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow'10 business days from date of application submittal-'Tentative only--must be CTR-1--od) <br /> ❑ CHECK BOX TO EXFEDITE _Q — EE(CAS 'OR C �ON�LY) REQ�UEST PROCESSED N3 BUSINESS 9AYS <br /> SIGNATURE OF APPLICANT��, � DATE <br /> Electronic Information: ❑ List n Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> 7 C")aa' t_1 <br /> 2. y <br /> 4. <br /> 0 <br /> 6. nit:3 <br /> 6. Q\ <br /> In�Jt 4 <br /> 7. <br /> 8. <br /> El <br /> 9. unit 5 <br /> L0 0 Unit 6 <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL RffA-LTH-DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT Lj SOLID WASTE FACILITYfVEIIICLE <br /> ❑OTHER CLEANUP SITE(KION-LOP) FoCia FACILITY F-1 WASrE TIRE <br /> UNDERGROUND TANK(MON(TOMNGIREMOVAL) ❑00(;KENNEL L]DAIRY <br /> HAZARDOUS WASTE GENERATOR pyl ❑CHICKEN RANCH❑ El WASTEWATER TREATMENT PLANT <br /> TIERED PFRmiTTro FACILITY MOTELJHOFEL El PUMPER TRUCKfYARDICHEMICAL TOILETS <br /> EITATTOO/BODY PIERCING ❑POOLISPA ❑LAND LlSr APPLICATION SITES <br /> [I MED(CALWASTE FACILITY KOTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC;PERMIT RECORDS ARE AVAILABLE FOR REVIEW-. MONDAY-FRIDAY 8:00 AM-5:00pm(ExCLUDING HOLIDAYS) <br /> 1. List U112 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 live 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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> E—H_D USE ONLY <br /> CW ' <br /> 6 V CP_ <br /> 9 q,- ea fd <br /> 8127109 <br />