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I I/z5/ZU" la :ar tA), [�j001/001 <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTY . EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/e d U <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> VV <br /> APPLICANT: � � y� BUSINESSIAGENCY: <br /> /� C ,t'1P_-Y-Y'11i Y1 �P_1`t)ICAC <br /> ADDRESS: � 4-i'Z11.L pctnt�,_ cltylstatelzlp ��[1 MY1P 7 <br /> PHONE(1): \ A01 PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: 1)22,_ 8111� Time: II ,4M <br /> (Plaase allow 10 business days from date Of application submittal-"Tantauva only-must be confirmed) <br /> ❑ CHECK SOX TO EXPEDITE RE T-8 S FEE(CASH 0C E,CKQONnLY)-REQUEST PROCESSED IN 3 eU31NE_3S/po_AYS <br /> SIGNATURE OF APPLICANTDATE '�/ 9CJ_s <br /> Electronic Information: ❑ List❑ Map-Description: f <br /> FILE ADDRESS EHD USE ONLY <br /> Street M Street Name City U 1 <br /> 1• 5 N Ntut�2r St hoc kilo r1 5 Z W es,aata� <br /> 2. 8 Ol�k �—� n NodblUoue;t � n5 untz 'f F/ <br /> 3. lG P �, i <br /> . t� DrtH$4. <br /> 5. 1�71 MV <br /> Unit 4 <br /> 6. N } 1( IM) wlrW <br /> 7. U 5 <br /> 8. <br /> 9. <br /> .... _ Unite <br /> 10. <br /> Specific Date Range of Information Requested:From T"l 1 1�tG(.T_�i-. to l__.(I <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WASTE FACIUTYIVEHICLE <br /> OTHER CLEANUP SITE IN <br /> FOOD FACILITY WASTE TIRE <br /> UNDERGROUNDTANK(MONITORINaIREMOVAL)D( DOG KENNEL DAIRY /Z/IId'Y <br /> HAZARDOU8 WAS TE OENERATORO( CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMRRD FACILITYd- MOTEUHOTEL PUMPER TRUCKIYARD/CHEM TOILET$ <br /> TATToo/BODY PIERCING OOLISPA -7^ U is,APPLICATION SITES <br /> P!kMtVICAL WASTE FACILITY OTHER(PLEASE SPECIFY) Alt Res <br /> WELL AND SEPTIC PERM R RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 5:00 AM*O0PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ton 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)404-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Appllcatlons 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> p co Do2�3/5 4 �. <br /> EHD 48-05 II/M108 PUBLIC RECORDS RELEASE APP FORM <br />