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uni c rtci.civcu <br /> SAN JOAQUIN COUNTY EHU LUG NUMBER <br /> r 6�r iiln� EN IONMENTALHEALTHDEPARTAENT <br /> -�'1 <br /> 600 East Main Street, Stockton, CA 95202-2708 ('► /,2 <br /> Telephone: (209)468-3420 rax, (209)464-0138 Web: www.sjgov3orhj V <br /> Iij,; ., , :- PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:"' - BUSINESS GENCY: JQN IA lf,e t^ At n <br /> ADDRESS: DOW 10 61 0 �'^---- <br /> PHONE(1):�Z.$� 2�Ci ) PHONE(2): 24?i-4;0,-7&4E FACSIMILE: R'Z.S'tI�7 Sr[r 2 <br /> TENTATIVE*APPOINTMENT DATE:_ *tom Time: <br /> (Please allow 10 business days from date of ApIflicatiob submittal-"T al�nly-must be confirme <br /> dr <br /> CHECK BOX TO EXPEDITE REQUEST- .00 FEE(C H CHECK RE EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ Lis Map- cription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street If Street Name City ❑ Unit 1 2. <br /> ❑ unit 2- <br /> 3. <br /> 4. Unit 3 <br /> 6, Unit4 <br /> 7. <br /> $ ❑ Unit 5 <br /> 9. <br /> 10. /poolnit6 <br /> Specific Date Range of Information Requested: From to <br /> l/ ENVIRONMENTAL HEALTH DEPARTMENTFILF�S- <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) 11 HOUSING ABATEMENT =WASTE FACILITY/VEHICLEER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY 171 WASTE TIRE <br /> RGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 11DAIRY <br /> AZARDOUS WASTE GENERATOR 1:1CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> 11 TATTOOIBODY PIERCING ,❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY p OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRID 8:00 A111-5:00 . EXCLUDING 66LIDAYS. <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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> *** If you should need further assistance please contact Diene Martinez C (209)468-3425 directly. Thank You*** <br /> EMD 48-06 8/1412006 <br />