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TO•d _Idlo.i <br /> DATE RECEIVEDcilopy <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTME <br /> 304 East Weber /lvenue, 3'd Floor, Stockton, CA 95202- )R <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www,sjgov rg/ d <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY:ADDRESS.-4%k,-,( <br /> -4%k,-,(C� <br /> PHONE(11 PHONE(2): �1 FACSIMILE: �� "'t Z5� LL7 <br /> TENTATIVE`APPOINTMENT DATE: M��O(c_� Time: eZ1-c'Cn­-' <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> © CHECK BOX TO EXPEDIEQ S $95.00 FEE(CAS CHECK ONLY),REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ' <br /> UNIT DISTRIBUTION *217 Unit-1 In Unit 2 0 Unit 4 ❑ Unit 5 ❑ Unit 6 C3Other(electronic/lists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> j Street 9 Street Name City_ <br /> )ft((_C4'FA <br /> 6. <br /> 7. <br /> 8. <br /> _� <br /> d( --...—----- — - - <br /> LL <br /> ila�� <br /> Specific Date Range of Information Requested: From � �� to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT A(401_I1)WASTE FACILIIY/VEH(GLE <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) d DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRuCK1YARDICHEM TOILET$ <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIPY) <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(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138-pr mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> END 49.06 �T <br /> onroe <br /> TO/TO'd 28172 17821 916 2-nIn9SOd - NODUM63i SZ:bT 21082-2E-onu <br />