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DATE RECEL11lrp� :: EHD LOG NUMBERr <br /> SAN JOAQUIN COUNTY <br /> IN- 1ENVIRONMENTAL HEALTH DEPARTMENT <br /> 7� <br /> 200 <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> hone. (209) 468-3420 Fax, (209)464-0138 Web: www.sjgov.org/ehd <br /> T <br /> L);N P. <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; BUSINESSIAGiENCY: <br /> ADDRESS: CITYISTATEIZIP; <br /> PHONE(1): -J%Q-gl3to rHONE(2): (Sl,) 27% FACSIMILE: At6 '1*0 -9l,P3 <br /> TENA 711VE'APPO INTM ENT DATE. Time: <br /> (Pleu%e allow 10 bvrpinesi5 dap from date of application submittal-*Tonfativo only-must ba confirmed) <br /> [j CHECK BOX TO EXPEDITE REQLIES -$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: 0 List❑ Map-Description: <br /> FILE ADDRESS FHI)USE ONLY <br /> Street# Street Name city ❑ <br /> unit i <br /> 1. glio 44y"; i WA-1 -iL_v <br /> 2. -rut, 1 i Unit 2 <br /> 3. !jnj I <br /> 4. -$or 355 02nit 3 <br /> & <br /> "m4a <br /> 7. <br /> 8. <br /> 9. <br /> El Unit 5 <br /> Q Unit GA <br /> Sp9cific Date RaLnGlo of information Reauested: From to FOOV14 <br /> ENVIRONMENTAL HEALTH DEPARTMENT'FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q HOUSING ABATEMENT ❑SOLID WASTE FACILIIYNEHICLE <br /> Eg OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> [T UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> 6fl HAzAmous WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> D TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> EITATTOOMODY PIERCING [I POOLISPA EILAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 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 un to ton addresses in the space above. Select the type(z)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 or malt the address indicated above. A1jdr9G6 <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Application&received after <br /> u <br /> e <br /> D <br /> appropriate p <br /> N( <br /> prH <br /> op <br /> HOLIDAYS) <br /> dM66 <br /> 'i:r <br /> v jk <br /> received <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 ton(10) <br /> 'r <br /> days after receipt of application. The files will bo hold for a maXIMUM of five business days for review. A4nppolntmonta <br /> 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 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 staff at the expenge.of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> PHO USP ONLY <br /> END48-m <br /> 07/29110"I ) <br /> V"_WVA% Wp "VAA;v*4 Wts(&ril Y L"&& <br /> 100/100XV3 1.9'1Z0 010Z/C1/130 <br />