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inn 014 pyo 0p00 tKN well wL 4001/001 <br />I !i <br />( ��-J,},1� EHD LOG NUMOER <br />`�, SAN JOAQUIN COUNTY <br />I�fiA� 708 ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.ar hd <br />E:N�,II�lliui�E-IVT HEALT�1 <br />pEen ; ; )y RV! -,E9 PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: I L�(� I BuusiiN)nSSIIAA}GENCY: <br />ADDRESS:_/'�7i7 Ulu /�'1 /n.�i l( l�.A [� <br />PHONE (t):l 4n(: /�.�(� 9' 'IOC��—/ PHONE (2): �� W -046'15FACSIMILE: .Q5 <br />MGif ! t2D0� <br />TENTATIVE' APPOINTMENT OATS: Time: 9_ rJ,_' 1 <br />(Please allow 70 buslnass day6 from tlate of application SMbmlftal-'T&ntadva only- must be Confirmed) <br />CHECK BOX TO EXPEDITER VEST -;90.00 FEE (CASY OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS.. - <br />SIGNATUREOFAPPLICANT 4L,:Z/I1�__ i//i/lil�� DATE <br />Electronic Information: ❑ Llst ❑ Map— Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />OI ElUnit2 <br />Street <br />_ <br />Street Nam& CI@ <br />-75 <br />2. <br />3. <br />4_ <br />6. <br />7. <br />�} �1t�I�L�1��n <br />-- <br />Unit 3 <br />�nR4 <br />❑ Units <br />0 <br />9. <br />❑ Unit6 <br />10. <br />Specific Date Range of Information Requested: From j 9M to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (LIST) CLEANUP SITE (LOP) O HOUSING ABATEMENT 0 SOLID WASTE FACILITYIVEHICLE <br />}}y..,,,((( <br />O OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY 171 WASTE TIRE 3 I1 <br />UNDERGROUND TANK(MON(TORINGIREMOVAL)D( 11 DOG KENNEL ❑DAIRY <br />)HAZARDOUS WASTE GENERATOR 71 CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />0 TIERED PERMITTED FACILITY D MOTELMOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br />TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />El MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 6:00 AM-5:OOPM - EXCLUDING HOLIDAYS. <br />7. 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 (20911464-0139 or mail to the address indicated above Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the EMD. Applications recelvad 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 revlew. 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 $98.00 deposit prior to review. <br />EHD USE ONLY <br />