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SAN JOAQUIN COUNTY EHD LOG NUMBED <br /> X011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600E East Main St. Stockton, CA 95202-3029 �Oqq <br /> a <br /> J00one: (209)468-3420 Pax: (209)464-013€3 Web: www,sjgov.org/ehd <br /> a©V,q jSERVIC"-_S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: &4'4e 4 Qtln, BUSINESSIAGENCY: <br /> ADDRESS: S e. 'C CITYISTATEIZIP: <br /> PHONE(i): 4tb- a-' 13 PHONE (2): FACSIMILE: w$o-ca(�o-s <br /> TENTA IVE-APPOINTMENTDATE: Time- <br /> (Please allow 10 buslnam days frorn date of application submittal-*rerrtative Only•mutt be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST Al FEE(CASH OR CHECK ONLY)-REQUEST PROCE$SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT� 4� k-\- DATE qvf -;to <br /> Electronic Information: ❑ List ❑ Map—Description:_ <br /> FILE ADDRESS EHD USE ONLY <br /> 8troet# Sheet Name City It 1 <br /> ) / 2 S. �fir_�� AJ nH2 <br /> 3. 3 <br /> Aa r <br /> V 4. -IS nit 8 <br /> 5. <br /> 4 ! v <br /> 7. <br /> ...-.,...,- i�Unita ,�PL <br /> 10, <br /> Spacific Data Rangn of Information Rnquastod: From a4 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES r(} <br /> Q 6INEDERGROUNo TANK(UST)CLEANUP SITE(LO P) ❑HOUSING ABATEMENT $ ID WASTE FACILrrYNEHICLE <br /> KHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY STE TIRE <br /> DERGROmTANK(MONrrORINGIREMOVAL) Q DOG KENNEL �RY <br /> ARDOUS WASTE OCN[RATOR ❑CHICKEN RANCH r STEWATER TREATMENT PLANT <br /> TIERED PERMnTEp FACILITY 0k, ❑WfLLIHOTEL timPER TRUCKtYARDICHWICAL TOILETS <br /> TATTOOIBODY PIERCING v_&E,o /5PA ND 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:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. S©lect the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected, Fax to(709) 0138 or mail to the ad(Ire5IF Indicated aboyl. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2, The EHD will notify the applicant if any EHb files exist. An appointment for review will be confirmed approximately ten(1 D) <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 fila not returned in the same condition as released will be reorganized by EHp staff at the expense of the applicant. <br /> Future rile reviews by the same applicant may require a$122 deposit prior to review. <br /> END USE ONLY <br /> o <br /> eled } , <br /> n q- <br /> eNo 48-Hq I-1 W a�na�ia <br /> tA0/ldOf YVJ SC-OL RO?IbL/9C <br />