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"A I t NLI,,;tivtu EHL)LOG NUMBER <br /> r = SAN JOAQUIN COUNTY <br /> - - ENV___JNMENTAL HEALTH DEPART <br /> 600 East Main Street, Stockton, CA 95202 <br /> - _ J7 Telephone: (209) 468-3420 Fax: (209)464-0138 Web: v.S' e <br /> CI <br /> PUBLIC RECORDS RELEASE APPLICATIO D <br /> APPLICANT: '- Ine—C61 <br /> L OX BUSINESS/AGENCY: <br /> ADDRESS: 3�D.�. 1�151tfAIVT�kScLGrtime,►rly_ CA �j56�/ // /n <br /> PHONE(1): Rll7^3 r)s—6700 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-$95.00 FEE CASH 0 CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT — DATE v <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. o 2 W,,,t S+(Xefi &HTY) 410 <br /> 2. 715 // Olt S T ,�Jnit 2 <br /> Unit 3 <br /> 4' 2 0 �, �� nn to <br /> nit 4 �\ <br /> 7' "Z t /� /I K' 6C� <br /> Unit 5 <br /> 8. .2Ao ( r d �� kS�-(62 <br /> 9. 2 2 ( e ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> L� <br /> VUNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT 11 SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 13 DAIRY <br /> ,HAZARDOUS WASTE GENERATOR CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY VMOTEL/HOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> EI TATTOO/BODY PIERCING ❑ POOL/SPA LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY 13 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 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> e� 6wi-e t,(,��„ S �� a l7 c `` UL <br /> EHD 48.06 5/16/2007 <br />