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DATE RECEIVED EHD LOG NUMBER <br />ENVOSAN JOAQUIN COUNTY <br />ONMENTAL HEALTH DEPARTffNT <br />600 East Main St. Stockton, CA 95202-27 <br />27� l <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s 1 <br />PUBLIC RECORDS RELEASE APPLICATION <br />------------ <br />APPLICANT: AL n l� n� BUSIN <br />E <br />SS/AGENCY. _�'V1'tA-� <br />ADDRESS: EAL" CO/N`–'�rpK�. <br />PHONE 1): J10-0)0— I PHONE(2): FACSIMILE:, t0 -4''T/ ^ZC36 -_ <br />TENTATIVE* APPOINTMENT DATE: Time: r/c7' <br />(Please allow 10 business days from date of application submittal - *Tentative only - must be confirmed) <br />CHECK BOX TO EXPEDITE REQUESTQ-- $98w..0^,0n_FEE <br />�-(CASH —OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />- <br />SIGNATUREOFAPPLICANT �Yry` ✓ DATE Q 2� 6 <br />Electronic Information: ❑ List ❑ Map - Description: <br />In HOUSING ABATEMENT <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ FOOD FACILITY <br />Street # <br />Street Name City! <br />r C I Lf W G t ❑ Unit 1 <br />`1 J fl <br />1. <br />23�s <br />N. �7 K44e <br />11 WASTEWATER TREATMENT PLANT <br />O TIERED PERMITTED FACILITY <br />❑MOTEL/HOTEL <br />❑ Unit 2 <br />3. <br />❑./ POOLISPA <br />❑ LA�ND/I�'SE APPLICATION SI�T/ESS / <br />Unit 3 <br />4 <br />F1'tR1 NPS �rRON (}rJl/C.� <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY <br />5. <br />Unit 4 <br />6. <br />7. <br />L1 Unit 5 <br />n <br />8. <br />tJ <br />9. <br />❑ Unit 6 <br />y <br />10. <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />TANK (UST) CLEANUP SITE (LOP) <br />� <br />In HOUSING ABATEMENT <br />11 SOLID WASTE FACILITY/VEHICLE <br />tUNDERGROUND <br />THER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />13 WASTE TIRE <br />NDERGROUND TANK (MONITORING/REMOVAL) <br />13DOG KENNEL <br />O DAIRY <br />AZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />11 WASTEWATER TREATMENT PLANT <br />O TIERED PERMITTED FACILITY <br />❑MOTEL/HOTEL <br />17 PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOO/BODY PIERCING <br />❑./ POOLISPA <br />❑ LA�ND/I�'SE APPLICATION SI�T/ESS / <br />13 MEDICAL WASTE FACILITY <br />9`OTHER(PLEASE SPECIFY)/lD <br />F1'tR1 NPS �rRON (}rJl/C.� <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY <br />6:00 AM-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 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 $95.00 deposit prior to review. <br />EHD USE ONLY <br />***If you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br />EHD4846 91142006 <br />