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DATE --- --- ---- <br /> SAN <br /> ""SAN JOAQUIN COUNTY <br /> L`'D ENVIRONMENTAL HEALTH DEPARTMENT <br /> j U"�4 - n 2005304 East Weber Avenue, 31d Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web: www.sjgov.arg/ehd <br /> �ER0,NVE ��HEALTH <br /> p� "T/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ahe. i BUSINESS/AGENCY: e 4 <br /> ADDRESS: 11 d y _ •_ _ $ jrnQ � _9sni-7 <br /> PHONE(1): 91(12-,,285 (4_q.QC►` PHONE(2)•_ 9KP 1326 _11M FACSIMILE: 911'a $(DQ RIS)Q <br /> TENTATIVE*APPOINTMENT DATE:jQ 11:? )b'5 Time: IDA <br /> (Please allow 10 business days from data of application submittal-*Tentative only-must be confirmed) <br /> CHI=CK BOX TO EXPEDITE REQUEST-$93,00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Sp/7L0 FD <br /> UNIT DISTRIBUTION ❑ unit 1 ❑ Unit 2 Unit 3 Unit 4 Unit 5 Unit 6 ' ❑ Other(eiectronic/lists/maps) <br /> FILE ADDRESS EHD USE ONLY / <br /> Street# Street Name City <br /> d/ <br /> Z, - u - - <br /> CaMkr3- eta <br /> 3. <br /> 6. <br /> 7. <br /> 19. <br /> Specific Date Range of Information Requested; From _;7 C�'j 1 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Id UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT d SOLID WASTE FACILITYIVEHICLE <br /> Ig OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY IX WASTE TIRE <br /> 'UNoERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR CI CHICKEN RANCH 13WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY D MOTRUMOTEL ❑PUMPER TRUCK/YARDICHEN TOILETS <br /> O TATTOO/BODY PIERCING D POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL ANO SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REYIEw - MONDAY-FRIDAY 8:00 AM-S:COPM - 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 or 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$93.00 deposit prior to review. <br /> END/E-02-006 <br /> 1111!06 <br /> TOTAL P.01 <br />