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DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ft <br /> 13 21312 ENVIRONMENTAL HEALTH DEPARTMENT <br /> a 600 East Main St, Stockton, 3029 ✓/ <br /> Telephone: (209) 468-3420 Fax: (209)464-0101 388 Web:Web: www.sjgov.orglehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: yf BUSINESS/AGENCY:Qctwfq '� Conafjj. cep <br /> ADDRESS: n"l'i Lt Sw TL �t0 CITY/STATE/ZIP: ( IGJh;ngtanDc <br /> Zoo <br /> PHONE (1): ZOZ- PHONE(2): <br /> TENTATIVE`APPOINTMENT DATE: VM(4A 1 jerv1R11 PICcyG. FACSIMILE: -`INI - 7 8yVA(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 O 3-13 <br /> Electronic Information: ❑ List❑ Map-Description: _ <br /> FILE ADDRESS <br /> Street# EHD USE ONLY <br /> — -_ <br /> Street Name City <br /> � STi�annc <br /> 3. <br /> 4. -- � <br /> 5. - ❑Unit 3 <br /> 7. —_.. <br /> 8. --- <br /> 9. __ _ ❑UnHs <br /> 10. Lj <br /> — — <br /> Specific Date Range of Information Requested: From Ut —0 1— Z UnRs <br /> ( �SrnT <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES to <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ,FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONRORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL `PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTGOIBODY PIERCING aPOOUSPA SLAND 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-5:00PM(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 appropriate <br /> box(es). At least one file type MUST be selected. Fax tcof209)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 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 expense of the applicant <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> e,u�ase uHu <br /> EHD 48- <br /> Willi <br />