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D � SAN JOAQUIN COUNTY ENVIRONMENTAL RZALTH DEPARTMENT 304 East Weber Avenue, 3' Floor, Stockton, CA 95202-2708 E{�V1ROI`1it'!EP'J �EALTNTelephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd PEF;Cv:; i;SEF�VICES PUBLIC RECORDS RELEASE APPLICATION APPLICANT: tvX ADDRESS: 2I n BUSINESSIAGENCY: EHD LOG NUMBER z ( q 51 PHONE (1): I\/V ((JIYJ Tf W-. - PHONE{(22)::'1u-r— f -TI - ✓TJUI FAC51MILL::j v I v rriw�- I TENTATIVE* APPOINTMENT DATE: FJ6 • �U,vt (V-11% Time:- l30 AW (Please allow 10 business days from date of application submittal - *Tentative only -must be confirmed) CHECK BOX TO EXPEDITE REQU T - $93.00 FEE (CAS"R CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT itnr l DATE 12-116 TFWI3 -�0 �r/i7��►�.r��r.�lrs.�.]I�rr®/llr�r��,. �;r.��® Specific Date Range of Information Requested: From to ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK (LIST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY/VEHICLE �y Mw� OTHER CLEANUP SITE (NON{OP) 0 PDOb FACILITY C1 WASTE TIRE N UNDERGROUND TANK (MONIT1 RINGIREMOVAL) 173 DOG KENNEL In DAIRY .ILHAZARDOUS WASTE GENERATOR Cl CHICKEN RANCH O WASTEWATER TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPERTRUCKIYARD/CHEM TOILETS ❑ TATTOOIBODY PIERCING 0 PML/SPA ❑ LAND USE APPLICATION SITES MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMrr RECORDS ARE AVAILABLE FOR RENEW • MONOAY-FRIDAY 3:00 A113:0OPM - EXCLUDING HOLIDAYS. 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mall to the address Indicated above. Address ranges will not be accepted—for additional assistance with file addresses, contact the EMU. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available, 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. EHD 4842409 1114I05 MN4 QNV1XV0 %I111YWORD TETE C99 OTS XVd 90:tT 1VS S0/6T/TT Specific Date Range of Information Requested: From to ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK (LIST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY/VEHICLE �y Mw� OTHER CLEANUP SITE (NON{OP) 0 PDOb FACILITY C1 WASTE TIRE N UNDERGROUND TANK (MONIT1 RINGIREMOVAL) 173 DOG KENNEL In DAIRY .ILHAZARDOUS WASTE GENERATOR Cl CHICKEN RANCH O WASTEWATER TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPERTRUCKIYARD/CHEM TOILETS ❑ TATTOOIBODY PIERCING 0 PML/SPA ❑ LAND USE APPLICATION SITES MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMrr RECORDS ARE AVAILABLE FOR RENEW • MONOAY-FRIDAY 3:00 A113:0OPM - EXCLUDING HOLIDAYS. 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mall to the address Indicated above. Address ranges will not be accepted—for additional assistance with file addresses, contact the EMU. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available, 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. EHD 4842409 1114I05 MN4 QNV1XV0 %I111YWORD TETE C99 OTS XVd 90:tT 1VS S0/6T/TT 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mall to the address Indicated above. Address ranges will not be accepted—for additional assistance with file addresses, contact the EMU. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available, 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. EHD 4842409 1114I05 MN4 QNV1XV0 %I111YWORD TETE C99 OTS XVd 90:tT 1VS S0/6T/TT