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FAA <br /> EHD <br /> EHD LAG NUMBER <br /> )ATERRECEIVrIED/l SAN JOAQUIN COUNTY <br /> C� \ 9 J \J IIS ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> I- c 3 2, 700 ���5 Telephone : (209) 468-3420 Fax: (209) 464-0138 Web: wwwsjgov.org/ehd (o <br /> 13 <br /> Ep 1VUF: MIMCNt1 11EALIAii PUBLIC RECORDS RELEASE APPLICATION <br /> - - r` I'v41 ice .. - : ,- '� BUSINESSlAGENCY: <br /> APPLICANT: tt - <br /> ADDRESS" <br /> Z._ Ul✓` C'>`"j,. � f'ur-1 : ( 'SUS 3t LQ t L v <br /> PHONE (1): i\ 113"'1 �' � PHONE (2): /9t \a ZA - 1S f FACSIMILE: <br /> III <br /> TENTATIVE" APPOINTMENT DATE: 5�4yr•Gi Time: V4 <br /> (Please allow 10 business days from date or application submittal - "Tentative only - must be confirmed) <br /> ❑ CHECK BOX To EXPEDITE REQUEST - 593 00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN ;j BUSINESS AF <br /> DAYS <br /> SIGNATURE OF APPLICANT +� U —� DATE <br /> UNIT DISTRIBUTION 0Unit 1 r1Unit2 0UnIt3 Unit4 ❑ UnItS 0 Unit6 ❑ Other (electronichistelmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name AAA <br /> City <br /> 1 . 31tii �kocAta <br /> 2. ZLl`t I <br /> AAAAAAAAAAAAAAAA <br /> 3 . �-17 J LF <br /> 4. S - :n d t11.. �). C.. 1 �'V — reCerFII <br /> 5, g r � > f <br /> 6 . 23 ) . }t <br /> 9. F5 <br /> �- <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> w.AI ❑ HOUSING ABATEMENT 11 SOLID WASTEFACILITYNEVICLE <br /> � OTHERGROUNOTANK (UON-LO CLEANUP SITE (LOP) MFOOD FACILITY 13 WASTE TIRE <br /> ❑ UNDERGROUND <br /> TANK (SUE NON-LOP) ❑ DOG KENNEL 13 DAIRY <br /> ❑ UNDERGROU WSTE G EEHATOR GlREMDYAL) pCHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> EI F1pZARDOLR WASTE FACILITY <br /> ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ IIEREO PERMITTED FACILITY ❑ PODLISPA 1:3 USE APPLICATION S1153 <br /> ❑ TATTOOlBODY PIERCING <br /> 1:1 MEDICAL WASTE FACILITY OTHER (PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILF FOR RENEW - MONDAY-RaDAY 8:00 AMS:DDPM - EXCLUDING HOUDAYS- <br /> WIN <br /> 1 . List Bill 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 fele 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 <br /> will be re reorganized 593 00 eposit ps oar to reviewat hexpense of the <br /> applicant. Future file reviews by the same applicant <br /> EHD ae-oxws <br /> [nda5 <br /> z'd 8996-L99 60Z uellV ueq AI dgg:t70 g0 8Z 9ej <br />