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p � I �.. �+► EHD LOG NUMBER <br /> i� ilr �'M j ' � SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> X008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> fwt C+`err .fr F,��l•A �)i�' i �e <br /> IL PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1160,1"_ C BUSINESSIAGENCY: 11 �s <br /> ADDRESS: !f to E <br /> /, 7 City/state/Zip S�cx�Cfr,,L; C /I ! ;j 8cy <br /> '-[ <br /> PHONE(t): _?_0q — 4 V"��] PHONE(2): FACSIMILE: <br /> 5 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal *Tentative only-must be confirmed) <br /> ❑ <br /> CHECK BOX TO EXPEDITE 2RE7�//T- EE 5 FASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z11 Z/ Q <br /> Electronic Information: KList❑ Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> 1. <br /> '240 A P4kSfii1nM Lo[_-�, mo do <br /> 2. 2 f5r (9L^1pV it <br /> 3. 'Z A (w_s _qmoc, 2 <br /> na L <br /> 4. f} S L g ��u1hT3 <br /> 5. �!�iZW�STFZt�vLG IrJ L <br /> Unit a <br /> 5 60(2 1"t(4 VL Kkos I- z©�G iZ t Nag <br /> 7. ZuC — ,,,� mov <br /> Unit S <br /> 8. c r S 7 p.ti L / l+a d� <br /> 9. �� �� t [] Unit6 <br /> 10. S ,,� ' W dp <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> J r <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) {OUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> )KOTHER CLEANUP SITE(NON-LOP) d FOOD FACILITY ❑WASTE TIRE -� <br /> -X UNDERGROUND TANK(MONITORINGIREMOVAL)QC 0 DOG KENNEL ,DAIRY <br /> SCHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 171 WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY Q MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> Cl TATTOOIBODY PIERCING 0 POOLISPA 111fII.AND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 0 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. 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 f2091,464-0138 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 EHD files exist. An appointment for review will be confirmed approximately ten(10) <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 he <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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8104108 PUBLIC RECORDS RELEASE APP FORM <br />