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DATE RECEIVED. nnu wo rvvmocrt <br /> EASAN JOAQUIN COUNTY <br /> ONMENTAL HEALTH DEPAR <br /> 1868 East Hazelton Avenue, Stockton, CA 2 <br /> a ,0T ephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> roc E� �� JBLIC RECORDS RELEASE APPLICATION <br /> � A 4 <br /> �•T:`s)�J �_� �5\I1t�F.. s Fk F.-•C"°a� lJ '' V t <br /> APPLIFt te@ �# , ;V} �y BUSINESS/AGENCY: y, a <br /> ADDRESS:'L__004) k"`�1tin,�., \ •Z'(J 0 p CITY/STATE/ZIP:`t_�'VVI g1JLt(w� <br /> PHONE(1): r \GG PHONE(2): j(t (SZ,14�FZlO . FACSIMILE: X510 G 5Z.4`V3, <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 REQUES- J$1 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT S DATE tA- Z.- 7-0 I <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 Street Name City ❑Unit 1 <br /> 1. t L,�t�. er'� 1ck;iG4 s �l`J ( 1 thM�y C Aln <br /> 2. ❑Unit2 <br /> �J 3, <br /> �( 4. ,w unit 3 <br /> 5 <br /> 6. 'Unit 4 <br /> 7. <br /> 8. ❑Unit 5 <br /> 9. <br /> 10. <br /> jj-Unit 5 <br /> Specific Date Range of Information Requested: From to <br /> ,.�+ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> .EUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT �®`'0 ID WASTE FACIH NEHICLE 7 <br /> r+,'OTHER CLEANUP SITE(NON-LOP) E]FOOD FACILITY 59WASTETIRE 1i f���1fr I.J. ; <br /> � j'ONDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY PIP <br /> 3 <br /> ❑2� 1)AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ElWASTEWATER TREATMENT PL�ANr <br /> �❑✓"WIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA [:]LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY '•BoMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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(209)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 be <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$125 deposit prior to review. <br /> . Wh lMur, o (G <br /> EHD 48-06 811117 <br />