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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT I q <br /> 600 East Main Street, Stockton, CA 95202-2708 <br /> 2008 Telephone: (209)468-3420 Fax: (209)464-0138 Web: wNvw.sj_gov.org/eh'k 5 <br /> 17WR <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> I nIcf, <br /> APPLICANT:t)`NV(t'> "(RNPGQf?1 BUSINESSIAGENCYLINe :2 le <br /> ADDRESS: P , 6 a) 0 :5'tcl ci��! CA ,0t q Z G9 <br /> , C?, IF�!O)c <br /> PHONE(1): IRQ­Q-5�0o PHONE(2): 91-7 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 EXPEDITEkjUE OF A H OR CHECK ONLY)-REQUEST PROCESSED IN 3PUSINSS DAYS <br /> VX <br /> SIGNATURE OF APPLICANT n, T� DATE <br /> Electronic Information: E] Liscuwap-Description.y <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City El Unit 1 <br /> IRSO F C—t7C$�> R'I-,'> L_op I El Unit 2 <br /> 2. <br /> 64 <br /> Unit 3 <br /> 4. <br /> 1, oe <br /> Unit 4 6. <br /> 6q <br /> 7. D Unit 5 <br /> 8. <br /> 9. El Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 114 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT El SOLID WASTE FACILITY[VEHICLE <br /> K OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 11 WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY 13 MOTEL/HOTEL 13 PUMPER TRUCK/YARD/CHEM TOILETS <br /> • <br /> TATTOO/BODY PIERCING 13 POOUSPA 0 LAND USE APPLICATION SITES <br /> • MEDICAL WASTE FACILITY 0 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(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 Diane Martineze (209)468-3425 directly. Thank You*** <br />