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i <br /> EHD LOG NUMBER <br /> I DATE RECEIVED SAN JOAQUIN COUNTY <br /> � IL <br /> , \J h ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> c 2 ? 005 Telephone : (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> EPtV_U; OPdP.,4EiVT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESSIAGFNCY: <br /> APPLICANT: <br /> U •, � E � �lr. riaut ca IkLt!, <br /> ADDRESS: - - <br /> PHONE (11 : -1 ,.r -f , -T — to 'I 71­Li PHONE (2): 9 n Z: ( Sa > i FACSIMILE: <br /> TENTATIVE` APPOI NTMENT DATE: _3I' o ' Time: <.ptt <br /> (Please allow 10 business days from date or application submitral - •Tenralfve only - must hoconfirmed) <br /> ❑ CHECK Box TO EXPEDITE REQUEST - $93 00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 46 '1 1 DATE 7, tU ' <br /> 771 UNIT DISTRIBUTION � Unit i tDUnit2 1] Unit3 UnIt4 ❑ UnitS EDUntil!; ❑ Other (electroniclllstslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street C Street Name sd ,.. In Ciry <br /> [2, <br /> LI �2L-(`i ^ai-e,.•\� , ) - 1 I- y O eJ - :, .�.�- LAd 5 - Ab r 2 77 <br /> LI <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT � SOLID WASTE FACIUTYIVEHICLE <br /> 0ONOER CLEANUP SITEANK (NON-LOP) <br /> SITE (LOP) 0FOOD FACILITY 13 WASTE TRE <br /> OTHER CLEANUP SITE (NONI LOP) ❑ DOG KENNEL O DAIRY <br /> ❑ UNDERGROUND STEGE ERATOINGIREMOVAL) ❑ CHICKEN RANCH I7 WASTEWATER TREATMENT PLANT <br /> • HAZARDOUS WASTE FACILITY R ❑ MOTEUHDTEL ❑ PUMPER TRUCKNARDICHEM TOILETS <br /> ❑ TEREDPERMITTIERCIN FACILITY ❑ POOLISPA 0 LAND USEAPPUCATION SITES <br /> ❑ TATTOO/BODV PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> MEDICAL WASTE FACIUTY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW • MONDAY-FRIDAY 8:00 AM3:ODPM - IWIIIIIIIIIIII <br /> EXCLUDING HOLIDAYS. <br /> 1 . List up to ten addresses in the space above. Select the types) of files from the list above by checking the <br /> appropriate box{es). At least one file type MUST be selected. Fax to (2091464-0136 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, be confirmed licant If any EHD files exist. An appointment for review will <br /> 2. The EHD will notify the a PP <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 /> EHO 4"2-006 <br /> vt4+os <br /> Z <br /> d 9996-1 <br /> 60Z uoIIV UeA m010 d99 V0 90 8Z q9A <br />