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DATE RECEIVED 10 EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.or qy 0 <br /> PUBLIC RECORDS <br /> RELEASE APPLICATION <br /> APPLICANT: J('i//(QL�/ �C Y�l�/� �7 p USINESSIAGENCY: /Lwd 1/p_7��,f <br /> ADDRESS: Z7C L6IGf�C� /� CITY/STATE/ZIP: LLQ � [=F�J <br /> PHONE (1): 6-50 GSY" S PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> XCHECK BOX TO EXPEDITE REQUEST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name City C P Unit <br /> 1. cf�SC7 ' "7 {nca <br /> 2. l/,� B!LI 6J G ,11111 ' <br /> 3. <br /> 4 S 6e-? e? "G(txS t/ /( p nit <br /> 5. 1SiSn 1IC <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to r' <br /> ,.�/ ENVIRONMENTAL HEALTH DEPARTMENT FILES rye.J'Ufhj/ <br /> {7 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE I'n% <br /> .UNDERGROUND TANK(MONITORINGIREMOVALb(, ❑DOG KENNEL ❑DAIRY U I <br /> ,0 HAZARDOUS WASTE GENERATOR C4 ❑CHICKEN RANCH <br /> TIERED PERMITTED FACILITY � ❑MOTELIHOTEL ❑WASTEWATER TREATMENT PLANT <br /> ❑TATTOOIBODY PIERCING ❑PUMP ERTRUCKICARO SITES AL TOILET S.—1 <br /> ❑POOLISPA LAND 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-5:00PM(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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468.3425. <br /> EH U EONLY <br /> IISS <br /> W0 3 <br /> EHD 48-08 <br /> 8127109 <br />