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)ATE RECEIVED EHD LOG NUMBER ' <br /> (( �r 1 SAN JOAQUIN COUNTY <br /> 1VJ�I �1 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor, Stockton,CA 95202-2708 <br /> /` (Io. 3 <br /> 2 � Z005 Telephone. (209)468-3420 Fax: (209)464-0138 Web:www,sjgov.orglehd ; <br /> i 1 <br /> E�a`vi��Cl'�9�?ENi IiEhLTk1 PUBLIC RECORDS RELEASE APPLICATION <br /> ` /, <br /> 4 �`'•!'rli <br /> 1!57 .,"� C'�.�3 V".n !rt�`lJt BU5tNES.SJAGENCY :' <br /> APPLICANT: <br /> 3�'e- <br /> ADDRESS:ADDRESS: <br /> 1 <br /> SIMILE:r FAC } <br /> PHONE(11: r Y - � RHONE(2): - t�n 1 <br /> f, �]� <br /> TENTATIVE✓,�APPOINTMENT DATE: 3f`'r Ti <br /> (Please allow 10 business days from date of applicaUo n submittal-'7entaflve only-must be confirmed) <br /> CHECK Box To EXPEDITE REQUEST-$93x00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS ; <br /> SIGNATURE OFAPPLICANT �'J'V '� DATE _L <br /> UNIT DISTRIBUTION ❑ Unit ❑unit ❑Unit 3 Unit4 ❑'Units ❑ unit ❑ Other{elecixonichisWrriaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street Strom Name j F;h,` 41, city W <br /> s n <br /> 4. <br /> I l r I-- <br /> `_roe sYL <br /> 7. rZIS <br /> II <br /> 10. to <br /> Specific Date Range of Information Requested:From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES x � <br /> N,{ ❑Housiw ABATEMENT - I ❑SOL1DwASTE FAcIL1TYNEHICLE <br /> y i vNDERGROLIND TANK(UST]CLEANUP SITE(LOP) FAD FAC1L►YY �� ❑WASTE Tti� <br /> ❑OTHER CLEANUP,SrT'E(NON-LOP) M DOG KENNEL 0 DAIRY I <br /> ❑ UNDERGROUND TANK(MowiToR1NGIREMOVAL) CI RANCH E3 WASTEwATERTREATNIENTPLANT <br /> C7 HAZAROous WasTEGervERAroR EnPUMP£RTR;urXNARDlC6FMTOILM <br /> 13 TIERED PERMITTED FACILITY E3 MOTELPHOTEL <br /> ❑TATTOCJBODY PIERCING C3POOLlSPA 13 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACflJTY <br /> ❑OTHER(PLEASE SPECIFY) l <br /> WELL AND SEPTIC PERMIT RECO RDS ARE AvAi-ABLEFOR REVIEW- MONDAY-FRIDAY8:00A -5:00PM - 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 <br /> MUST be selected. Fax to 249)454-0135 or mail to the address <br /> ssistance with fila addresses,contact <br /> indicated above. Address ranges will not be accepted—for additional a <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.fora maximum of five business <br /> days for review. Appointments should be scheduled accordingly. 1 <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> i I <br /> application may be submitted when the file)s available. ,i <br /> 4. Any file not returned in the same condition as released will be reorganized by FHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$03.00 deposit prior to review. } <br /> iI <br /> r- -^ 4 <br /> EHD 4EA2-M6 ' <br /> 1114145 <br /> Z'd 8996-L99 60Z uollV uen m9JC1 d99:170 50 8Z qaj <br />