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DATE RECEIVED EHD LOG NUMBER <br /> ` 'c SAN JOAQUIN COUNTY <br /> {�CCjE�VE® ENVIRONMENTAL HEALTH DEPARTM <br /> Ak <br /> TT 111 . 600 East Main St. Stockton, CA 95202-3029 <br /> Melephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> _tvvPE MirlsERvc St�W <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: tG�////x/ /V,¢wo-rW BUSINESSIAGENCY //Io10E1z7 ' SGC[r7torr <br /> ADDRESS: 52-66 -A Xr, t4 k Q/C/VE CITY/STATE/ZIP 0z(6 t 1c, . c.4 %yS�'g <br /> PHONE (1): J11Y- L/57-Q2Y3 PHONE (2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. l D Sb S, A m o cv D Sr-- 57'6 T61- <br /> 2. <br /> 6N2• / 4 WA-CNcrr — Cf�_TJy 1 _ ❑ Unit 2 <br /> 3. <br /> 4, Unit 3 <br /> 6. Unit 4 <br /> 7 <br /> 8, ❑ Unit <br /> 9. <br /> 10. ❑ Unit s <br /> Specific Date Range of Information Requested: From a If t to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> [�OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ©WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ®WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATToo/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑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 f 3r 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 sta ff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> EHD USE ONLY <br /> 8111'. <br /> EHD 48-Ofi <br />