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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> , ENVIRONMENTAL HEALTH DEPARTMENT <br /> / 1868 East Hazelton Avenue; Stockton, CA 95205-6232 <br /> i J � elephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> V Io <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:y f4J/��/• BUSINESS/AGENCY: <br /> Er,fSSi IA'l GENCFYA:C�6 <br /> SGI�MG1ICL2yE�ON�`JI <br /> /,IP'- <br /> ADDRESS: D Jra/, X ([ YCITY/STATVZIP: <br /> PHONE(1): PHONE(2): <br /> T IT, TIV�E'APPOINTMENTDATE: OV (_/4. <br /> 9 <br /> C�Z� <br /> n T 7 C, r C . f%x j Time r <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmad) <br /> ❑CHECK BOX TO EXPEDITE REQ y E (C rOR CHECK ONLY)-REQUEST PROCESSED IN 33 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT i ' f --� DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city Unit <br /> 2- If ll Unit <br /> 3. 1 t <br /> 4. �. F-- <br /> 0 Q Unit 3 ym <br /> 5. f'I1 ' 4 f/ � y FVle- 3 green/ / pj�UWt� G %) <br /> 6.. t=. Ch�� O G✓aS Cita�rr W h) E, 1171Sk Unit4 cj//�'��Z <br /> i <br /> oc(tlf ❑Unit5 <br /> 7. <br /> 8. L —� - &dre, <br /> 9. /' �.( So d A EC6 WAy. /fin - <br /> 10. �/jiti1 �E%Y �J5 /unS� Wa644_ G Cvl. [tJIn*R <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HE TH DEPARTMENT FILES <br /> 10 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACIUTYNEHICLE <br /> `OTHER CLEANUP SITE(NON-LO P) F1 FOOD FACILITY E]WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERmTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑-MEDICALWASTEFAciuTY -[aCOMPLAINT 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(16) <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 atthe expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> EHD LISE ONLY <br /> EHD 48-06 Bltllt <br />