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DATE RECEIVED! EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> � t008 600 East Main Street, Stockton, CA 95202-3029 <br /> JUNTelephone; (209)468-3420 Fax: (209)464-0136 Web: www.sjgov.org/ tdD <br /> +N, - -I <br /> Eta/IPOiVn1EN.,i HEN LTi PUBLIC RECORDS RELEASE APPLICATION <br /> P �r,ao f^F v <br /> APPLICANT: ee yy BUSINESSIAGENCY: <br /> ADDRESS: 3tg-2,1.4I lA'dA•A; <br /> PHONE(1): PHONE(2): FACSIMILE: qfA L490 - ofib--� <br /> TENTATIVE*APPOINTMENT DATE: Time' <br /> (Please allow ton business days from date of application submittal-•Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST•19$00 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE I-OE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> et <br /> Stre ! Straot Name City _ 0 Unit 1 <br /> 1' 14 ). ."J vL <br /> 2• ISb W - InUnit2 <br /> S. ;z UrCrZah. c� G _ <br /> 4. Jojj <br /> S' 1050 ion dQ 510,— Ion - Plllnitd <br /> T. r L . L -9 / <br /> B• ❑Unit S <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range Of Information Requested:From MID to1' '5e.�1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HDusINa ABATEMENT ❑$OLID WASTE FACIUWIVEHICLE <br /> ]�.OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY L7 WASTE TIRE <br /> GrUNDERGROUND TANK(MONITORINOIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY O MOTELIHOTEL 0 PUMPFRTRUCKfYARDICHEM TOILETS <br /> 0 TATTOOBODY PIERCING 0 POOUSPA 0 LAND USE APPLx:AnoN SITES <br /> O MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPRC PERMIT RECORDS ARE AYA-AaLE FOR REview- MONDAY•FmnAY 8:00 AM•5:0oPM -EXCLUDING HOLIDAYS. <br /> i. List up to ten addresses in the space above. Select the types)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mall to the above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> be processed the next business day. <br /> 2. The EHD will notify the applicant If any END files exist. An appointment for review will be confirmed approximately ten <br /> days after receipt of application. The fires 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 the EHD staff may not be Immediately available for review. A new application <br /> may be submitted when the file Is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$98.00 deposit prior t0 review. <br /> EHD USE ONLY <br /> EHDYde 10IM? PUBLIO RECORDS RELEASE APP FORM <br /> L00/L00l1 XVj 9Z 6L 6o0Z/60/90 <br />