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DEHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 21 2013 ENVIRONMENTAL HEALTH DEPARTMENT <br /> oC 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> -- -- ---- - - � iTtbne:(209)-468-3420 Fax: (209)-464-0138-Web:-www.sjgov.org/eh - ---- — - - -- <br /> E�akIS7xVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT-. BUSINESSIAGENCY: <br /> ADDRESS: .-. CITY/STATE/ZIP: <br /> PHONE(1): u-� z �O PHONE (2): FACSIMILE: <br /> TENTATIVE*APP FNfMENTDA Time: <br /> (Please all, 10 bulsiness days fr date of application submittal-*Tentative only-must be confirmed) <br /> ❑_CHECK BOX TO EXPED 25 FEE / CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> GNATURE OF APPLICANT �_ IV I DAT �d,_ =4._ Z��.� <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY j <br /> Street# Street Name City l Unit 1- <br /> q2. <br /> © Unit 2 <br /> 3. <br /> 4. ' <br /> El Unit 3 <br /> 5. �l <br /> 6. ILA Unit <br /> 7 <br /> 8. <br /> Q Unit 5 <br /> 9. <br /> / <br /> 10. EJ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) EDMEDICAL WASTE FACILITY SOLID WASTE FACILITYEHIC <br /> ( ) �I {gyp f <br /> OTHER CLEANUP SITE(NON-LOP) I -HOUSING ABATEMENT WASTE TIRE 5 <br /> QUNDERGROUND TANK(MONITORINGIREMOVAL)�f FOOD FACILITY DAIRY � to-Z25-43 <br /> ABOVEGROUND TANK � CHICKEN RANCHI DOG KENNEL WASTEWATER TREATMENT PLANT <br /> ^41J HAZARDOUS WASTEIHAZARDOUS MATERIALS pC MOTEL/HOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITYK_ POOLISPA LAND USE APPLICATION SITES <br /> TATTOO/BODY PIERCING COMPLAINTIRESPONSE RECORDS OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:0 M-5.00PM(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 END 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. ***BOXED AREA-EHD USE ONLY*** <br /> Zo3 m ►� <br /> to-ZP I 5 1 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 9/4/12 <br />