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- -, i7 ._. ,mat : :20998369E0 U I / t <br /> R E 0"'�' E 1',v"E <br /> i <br /> DATE RECEIVED SAN JOAQUIN COUN`I Y EHD LOG NUMBER <br /> jQN 0 7 � ENVIRONMENTAL HEALTH DEPARTMENT 590lq <br /> y 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIRONMENT�aL I��To'ne: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> DEPAPTMEN`I` <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPi (CANT: . i` AUSINESS/AGENCY: _Iver � I s lyir. <br /> ADDRESS: F4� CITYISTATEIZIP: }m <br /> PHONE (1): 7-,Q,9 -37-2-,^j PHONE(2): FACSIMILE:+ r <br /> TENTATIVE"APPOINTMENT DATE:_01/1t/fa Time: (� <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> i <br /> SIGNATURE OF APPLICANT A aDATE <br /> Electronic Information: ❑ List[:1 Map-Description: <br /> FILE ADDRESS EI ID USE ONLY <br /> Street# Street Name City <br /> ioC)�o v� r1rJ t trf <br /> 2. � fl Vt�[ lwv�1— Il Unit 2 <br /> 4. Y <br /> Unit 3 <br /> • 5_ <br /> 6. <br /> 7 - ----- Unit4 <br /> a <br /> Unit 5 <br /> 9. <br /> j 10. - Unit B <br /> i <br /> i Specific Date Range of Information Requested: From to �iQ1�' r�Vti <br /> ENVIRONMENTAL HEALTH DFPARTMENT FILES I — � <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) [j HOUSING ABATEMENT <br /> 2}SOUD WASTE FACILITYNiIIICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> i S UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑ <br /> DAIRY <br /> twit r <br /> Z HAZARDOUS WASTE GENERAT ❑CHICKCN RANCH [:1 WASTEWATER TREATMENT PLANT ]I`IZ-1 <br /> TIERED PERMITTED FACILITY .' \ L]MOTCLIHOTEL ❑PAMPER TRUCKNARDICHEMICAL TOILLTS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA (]LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 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 indica ed above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> j3:00 pm will be processed the next business day. <br /> i 2. The EHD will notify the applicant if any FHD files exist, An appointment for review will be confirmed approximately ten (10) <br /> j 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 /> 0 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$122 deposit prior to review. <br /> i EHD USE ONLY <br /> I — <br /> 1 <br /> eM48-os — 0712Bl10 <br /> I <br />