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T CD-., - EHD LOG NUMBER <br /> 11` 1 SA`���I�� SAN JOAQUIN COUNTY <br /> �U ENVIRONMENTAL HEALTH DEPARTMENT <br /> A(tY j ���� 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www-sjgov.org/ehd <br /> ENVIR(li NIM r HEA['1 H PUBLIC RECORDS RELEASE APPLICATION <br /> pER APPLICANT:-:5- rune BUSINESSIAGENCY:�1G�vye.� 4 C_ <br /> ADDRESS: Q ?A j_f4J0_& k,1 &i✓d 1!5& /V1 CITY/STATE/ZIP._" efll�yE cies. G} gSG7lJ <br /> PHONE(1): G) PHONE(2): $ Q j0 FACSIMILE! ?/& <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 REOUEST- 115 FEE(CASH OR CHECK ONLY)-REOUESTT PROCESSED IN 3 BUSINESS DAYS <br /> t <br /> SIGNATURE OF APPLICANT *14i+4lrl DATE-.5-/O -/D <br /> Electronic Information! ❑Lilt❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Y Street Name City ❑Unit t <br /> 2• <br /> VL <br /> Unit2 <br /> V0 a. <br /> 4. UnH3 Q <br /> 0• Unk4 <br /> 7. <br /> S. <br /> ❑units <br /> 9. <br /> 10. ❑Unit 5 <br /> Specific Date Range or Information Requested: From to <br /> FILESENVIRDNMENTAL HEALTHDwENT ®le srl ri, <br /> �i•le <br /> UNVEROROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIDiYNEHICLE I I 2 <br /> OTHER CLEANUP Srrs(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE /•_�/' ^ (('J_ <br /> UNDERGROUND TANK(MONITORING/REMOVAL)%Zk ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTEGENERATORo{ ❑CHICKEN RANCH ❑WASTEWATERTREATMENT PLANT Y yKZ,11G <br /> ❑TIERED PERMITTED FACILITY D1, ❑MOTELIHOTEL - ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <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 5:00 AM-S:UQPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the apooe above. Select the type(e)of files from the list above by checking flue appropriate <br /> box(es). At least one tie type MUST be selected. Fax to 8081464.0136 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 END files exiaL An appointment for review will be confirmed approxinately ten(10) <br /> days after receipt of application. The flies will be held for a maximum of fire 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 ba 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 /> S. if you need further assistance,please contact Diane Martinez,at(2D9)468-3425. <br /> E us ONLY <br /> ` <br /> EHo 4" 3127100 <br />