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�La .roc oielY� r. nliel <br />Fes, --- --_ —_..- <br />DATE ",,. .,... .........�.. <br />li " 5 �VJ SAN JOAQUIN COUNTY <br />FE " �_ <br />SD ENVIRONMENTAL HEALTH DEPARTMENT <br />01lwI`� - ' 20D5 304 East Weber Avenue, 3d Floor, Stockton, CA 95202-2708 .'07 q ofTelephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.arg/ehdj/ <br />Eb9 <br />P RMIENR 1(,F,q PUBLIC RECORDS RELEASE APPLICATION <br />S ✓l('FC <br />APPLICANT: y_1CYC'\e_ Ft\Rlh\.iV)(A BUSINESSIAGENCY! <br />ADDRESS: I fit\ did ?kcALuL& Qct, r— ---. SaoKCAf(1Q .ICI 9ss3i _ <br />PHONE(1): -tRI(D ^a5b C4grQq PHONE(2): Cil(.P 9(n'i_ —I(M FACSIMILE: CJ(la 8(a.'Z 81M <br />TENTATIVE" APPOINTMENT DATE: 10 15 Time: 0 n <br />(Please allow 10 business days from date of application submittal - "Tanrar/ve only - mustbe Col <br />CHECK BOX TO EXPEDITE REQUEST -$93.00 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED I <br />SIGNATURE OF APPLICANT DATE <br />UNIT DISTRIBUTION ❑ Unit 1 ❑ I Urt/3 Unit 4 ❑ Unit S <br />Unit 6 ❑ Other (electroniolists/maps) i <br />Of SOLID WASTE FACILITY/VEHICLE <br />OTHER CLEANUP SITE (Nowt -OP) <br />FILE A RESS <br />EHD USE ONLY <br />Street K Street City <br />1. <br />ST <br />(A HAZARDOUS WASTE GENERATOR <br />2 0ca.- <br />❑ WASTEWATER TREATMENT PLANT <br />$LTIEREO PERMITTED FACILITY <br />3. � e u <br />T W <br />0 TATTOOIBODY PIERCING <br />4. <br />❑ MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIPY) <br />10. <br />Specific Date Range of Information Requested: From _2xpc)'�� to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />16 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />Of SOLID WASTE FACILITY/VEHICLE <br />OTHER CLEANUP SITE (Nowt -OP) <br />❑ FOOD FACILITY <br />» WASTE TIRE <br />ql UNDERGROUND TANK (MONITCRINWREMOVAL) <br />❑ Doc KENNEL <br />❑ DAIRY <br />(A HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT <br />$LTIEREO PERMITTED FACILITY <br />0 MOTEUHOTEL <br />❑ PUMPER TRUCK/YAROICHEM TOILETS <br />0 TATTOOIBODY PIERCING <br />0 POOLISPA <br />❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIPY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REYIEw - MONDAY -FRIDAY 8:00 AM-6:00PM - EXCLUDING HOUDAYS <br />1. List up t0 ten addresses in the space above, Select the type(s) of files from the list above by checking the <br />appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address <br />indicated above. Address ranges will not be accepted -for additional assistance with file addresses, contact <br />the EHD. Applications received after 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 <br />approximately ten (10) days after receipt of application. The files will be held for a maximum of five business <br />days for review. Appointments 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 <br />application may be 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 <br />applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />END M-02-006 <br />ItI406 <br />TOTAL P.0] <br />