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# 2/ <br /> 1 1 48,4M; <br /> EHD LOG NUMBER <br /> rIP-r: LPL� <br /> l ,V D1 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 3AN 0 L 00 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov. <br /> ENVIRCINWEi` ] HEALTH q0 <br /> PrRPkTiSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: SOJ-0-� li(broSe- BUSINESS/AGENCY: OiZ5 <br /> ADDRESS: a 70 a FS 1K. \Cja City/State/Zip CIA' 9Sg33 <br /> PHONE(1): at�- (a^lc1' a �S PHONE(2): FACSIMILE: Q110- <br /> TENTATIVE*APPOINTMENT DATE: a l a Iy° Time: 6100 aK. <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> E3 CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT (k &91 DATE I 141 oq <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City [] Unit 1 <br /> [2- <br /> k0. it Unit 2 <br /> S S-7 <br /> ab`� 1 Unit 3 <br /> a a�3Dnit4 <br /> a(0 <br /> 7. a -jp0 _ ❑ Unit <br /> i 8- a b R-12- <br /> 9- ❑ Unit 6 <br /> 10. 3 <br /> I Specific Date Range of Information Requested:From 1°►'30 to ccsenk <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEHICLE <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP)CLEANUP SITE(NON-LOP) 0 FOOD FACILITY Y WASTE TIRE <br /> iTHER <br /> rNDERGROUNDTANK(MONITORING/REMOVAL) 17 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH El WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER TRUCK/YARDICHEMTOILE TS <br /> d TATTOO/BODY PIERCING 0 POOUSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8/04108 PUBLIC RECORDS RELEASE APP FORM <br />