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0 0 <br /> DATE RECEIVED 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.org/eh <br /> 1I PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: W�w�� S2�OR ( _ BUSINESS/AGENCY: Ey\\j-N y) <br /> ADDRESS: Cn op CITYISTATE/ZIP: ".nw'�\�c LA 9q�p� <br /> PHONE (1): Sl0—` ;up —"aS-O'l PHONE (2): FACS�IMILEE: S!y-SSS - SSI 1 <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 REQUEST-$125 FEE SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT2LL DATE I thg ZO i I <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> �r0.L D�� <br /> 2. gB-1 7�. R1 L N �>nit <br /> 3. <br /> 4. <br /> 5. <br /> 6. it 4 <br /> 7. <br /> 8. ❑Unit 5- <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES C <br /> UDERGROUND TANK(UST)CLEANUP SITE(LOP) F1 HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE �L <br /> •� <br /> �OTHER CLEANUP SITE(NON-LOP) El FOOD FACILITY ❑WASTE TIRE �* <br /> ��CINDERGROUND TANK(MONITORINGIREMOVAL)X F1 DOG KENNEL El DAIRY <br /> �� <br /> LL, t1AZARDOUS WASTE GENERATOR CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ON\ ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT 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 /> —IIS_ V US O Y l- <br /> EHD 48.06 VIM <br />