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DATE RECEIVED <br />APPLICANT: <br />CKU LUU INUMbtK <br />USAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 0 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.Sjgov.org/ehd_ I �� <br />PUBLIC RECORDS RELEASE APPLICATION <br />ADDRESS: �/(jo s. /11�11 <br />PHONE (1): &3(o q31 7Y// PHONE (2): <br />BUSINESS/AGENCY: (' t/uL_t <br />TENTATIVE" APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - *Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE <br />SIGNATURE OF APPLICANT <br />OR CHECK ONLY) — REQUEST PROCESSED IN 3 BUSINESS DAYS <br />DATE <br />I UNIT DISTRIBUTION I 9FUnit 1 ylr Unit XUnit3,e7Unit4 jWUnjt5 g0`IUnit 6 ❑ Other (electronic/lists/maps) <br />y <br />w�� <br />mom <br />••a <br />USE • <br />®-EHD <br />Street N <br />lu <br />HIM101IIL21iTilrmlrhm. <br />n��M <br />• � <br />u2uJinlf�L�LyIIICyUJ <br />�is►�� <br />1 <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES 0 <br />UNDERGROUND TANK (UST)CLEANUP SITE (LOP) OUSING ABATEMENT LID WASTE FA CI UTY/VEHICLE <br />OTHER CLEANUP SITE (NON -LOP) ODD FACILITY WASTE TIRE <br />UNDERGROUND TANK(MONITORING/REMOVAL) DOG KENNEL / DAIRY l <br />HAZARDOUS WASTE GENERATOR I HICKEN RANCH �(, ASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY 1 ` OTEL/HOTEL PUMPER TRUCK/YARDIC HEM TOILETS <br />TATTOO/BODY PIERCING �. ` l OOUSPA = USE APPLICATION SITES tA <br />MEDICAL WASTE FACILITY THEIR (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILAB E OR REVIEW - MONDAY -FRIDAY 8:00 AM-5:OOPM -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 <br />appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address <br />indicated above. Address ranges will not be accepted — for additional assistance with file addresses, contact <br />the EHD. Applications received after 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 <br />approximately ten (10) days after receipt of application. The files will be held for a maximum of five business <br />days for review. Appointments 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 <br />application may be 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 <br />applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />EHD 4"2-0N <br />1112104 <br />