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!)ATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY I <br /> • REUBVED ENPRO MENTAL HEALTH DE ARTMENT <br /> APR 19. 01 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> eI�plTone: (209)-468=3420 Fazr(209)-464=0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTALHEALTH <br /> ocRMiT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �/�y/V Odi�(jG/ BUSINESS/AGENCY: <br /> ADDRESS: / CITY/STATE/ZIP: &Pjje0 e 9 CZ,34 <br /> g/Op <br /> PHONE (1): OF—L qI PHONE (2): (22!?)iFS?— It FACSIMILEO? <br /> TENTATIVE*APPOINT ENT DATE: Time: <br /> (Please allow 10 business days from date of application submittaf-*Tentative only-must,be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU INESS DAYS <br /> SIGNATURE OF APPLICANT DATE 9 <br /> Electronic Information: ❑ List❑ a —Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ( <br /> ❑ Unit 1 l <br /> 1. —6- La i4dfklyn n( 1 <br /> 2. {t �° ej /1/ I',I), ❑Unit 2 <br /> 3. 1' <br /> 4. <br /> 5. �� I <br /> 6. <br /> Unit4 <br /> 7. <br /> a <br /> / <br /> ILI <br /> 8' - 1 r ElUnit 5 <br /> 9. <br /> 10. <br /> ❑ Unit 6,1 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> J;LUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNE�H/`CLE//,, __ 4 <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE �{y I(2, Nf Wt I I <br /> UNDERGROUND TANK(•�'��O,NITORINGIREMOVA* ❑FOOD FACILITY _ ❑DAIRY <br /> I�-I ABOVEGROUND TANK �C, ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLAN <br /> 2R HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑.MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List un 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. * BOXED AREA-EHD USE ONLY" <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br /> 914112 <br />