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s <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUINq I <br /> COGNTY f�� , <br /> _ .f <br /> r ENVIRONMENTAL HEALTH DEPARTMENT' <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Ventone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> �J ql <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Dolt &e- BUSINESS/AGENCY: �j�f��p�AQ >�� <br /> ADDRESS: 1 b1-j Brebac- Z CITY/STATE/ZIP: W441 �°L <br /> PHONE(1): 530-L/45_7-6 ,)j PHONE(2). ]`_3o FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: AS Sow► as qt/a a t Time: <br /> (7 �' (Please allow 10 business days from date of application submi I-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ON,LYJ-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> II C SIGN\\ATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> L <br /> j <br /> W .},Cr. Q va 1 J <br /> U { l /TG�11/`Q d ❑Unit 2 <br /> 3. ,�/� <br /> 4. p Unit 3 <br /> ,0 <br /> 6. p Unit4 <br /> 7. <br /> 8. mill, M ❑Unit 5 <br /> 9. t _rv. <br /> yvoi� <br /> 10. ;Ct7 Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> %NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILrrYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT )IIIASTE TIRE <br /> 9UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> [KiAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑.TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO]BODY PIERCING J5�COMPLAINTIRESPONSE 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(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$125 deposit prior to review, "`BOXED AREA-EHD USE ONLY <br /> Q Records provided by Staff-PPR Complete.Staff Name: <br /> EHD 48-06 914112 <br />