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1ci 1ic11 Vo. rnn 10001/001 <br /> DATE RECEIVED EHO LOG NUMBER <br /> SAN JOAQUiN COUNTY <br /> ENVIRONMENTAL HEALT14 DEPARTMENT <br /> 600 E. Main Street, Stockton,CA 95202-3029 ^ <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehZq <br /> �1V1j <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: <br /> PHONE 11): �lS� �b-'16t{,D PHONE(2): Ir' -L FACSIMILE: <br /> C U� <br /> TENTATIVE*APPOINTMENT DATE: V -Time: 'PM <br /> (Pla"o allow 10 buainaas days from data of application submittal-•Tantatwe only-must W confirmed) <br /> ❑ CHECK BOX TO ExPEDITE REQUEST- E(CASH O LY)-REQUEST PROCESSED IN 3 81t SS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: L] List[I Map-Description: 4 <br /> 77 <br /> FILE ADDRESS EHD USE ONLY <br /> unit I <br /> 2. S e Street Name CI - ❑ Una 2 <br /> 3 �nU <br /> i I t 4. --- —.._,.. Usk:! V� <br /> 1c01` 5. <br /> Unn 4 <br /> 8. <br /> L70.T ❑ Unit 6 <br /> 8. <br /> 9. <br /> • - -- ❑ Units <br /> it!! <br /> Specific Date Range of Information Requested:From to <br /> / ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ' <br /> )lUNDEROROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FAGLITYNENICLE o <br /> OTHER CLEANUP SIM(NON-LOP) 0 FOOD FACILt 0 WASTE TIRE <br /> UNDERGROUND TANK(MONITORINWREMOVAL) Q DOG KENNEL 11 DAIRY <br /> x'HAZARDOUs WASTE GENERAYOR 171 CHICKEN RANCH ❑WASTEWAMR TREATMENT PLANT 411114 <br /> 13 TIERED PERMITTED FACIU Y E3 MOTELIHOTEL Cl PUMPER TRUCKIYAROICNEM TOILETS <br /> O TATTOOIBODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY El OTHER(PLEASE SPECIFY) , <br /> WELL AND SEPDC PERMIT RECORDS ARE AVAILABLE FOR RENEW - MONDAY-FRIDAY 5:00 AM4:OOPM - EXCLUDING HOLIDAYS. <br /> T. List Up to tan addresses In the space above. Select the type(s)of files from the list sboVa by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464-0134 or mail to th ddress IndlGand 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 recelpt of application. The files will be held for a maximum of five business days for review. Appointment$ <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 /> 00 <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 /> ENDO 5 W. �8 weD <br />