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DATE RECEIVED EHD LOG NUMBER <br /> ` 6 SAN .1OAQUIN COUNTY <br /> [jECE �! ED EN*'(RONMENTAL HEALTH DEPARTOreNT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> 0 Melephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVPERM ESERV HEAL? H <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: /VgBUSINESS/AGENCY: fnoP�✓zry S�cuT �� <br /> ADDRESS: dLEL A X,- 44 kE /l/L/{IE CITY/STATE/ZIP: <br /> PHONE (1): ti7-fzV& PHONE (2): FACSIMILE: <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-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILL E ADDRESS EHD USE ONLY <br /> Street# Street Name City r <br /> / 4moo-0 _Sr. 57'GC/er6f- 5 <br /> 2. <br /> 1 X711 .- � /�M4 fF(.�✓i�_ /=. CIL,Tr� _ Unrt2 <br /> 3. <br /> -- !' <br /> 4. Unit 3 <br /> 5. <br /> 6. _- — -- - -- --- unit a <br /> 7. <br /> 8. ❑Unit <br /> 9. <br /> 10. p Unit 6 <br /> Specific Date Range of Information Requested: From AL Q//l �S to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILESLn�' <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE I1 I v <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ©WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL)�- ❑DOG KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR p� ❑CHICKEN RANCH ®WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATToolBODY PIERCING ❑POOL/SRA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type($)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 /> ( « 5 15 <br /> wam'4135 /) F <br /> EHD 46-06 eit�11 <br />