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Jun 30 09 01 : 02p Kraz -'- & Rssoniates SS8348`00 p. 1 <br /> DATE REOE1';'_D EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-30297 <br /> Telephone: 209 468-3420 Fax: 209 464-3138 Web: www,sjgcv or <br /> AIS PUBLIC RECORDS RELEASE APPLICATION <br /> 1�PFLfCANT ,j6P.(_ QIN(� BUSINESSIAGENCY: rkA N 4 <br /> ADDRESS: n?i ( . OEkLj�T-�) r� rG, Cityfstatolzip -& C A =' t <br /> PHONE(i)>� � ti U r-�<s�� PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: � �Time: <br /> (Please allow 30 business days from date of application submittal-"7c»fative only-must be confjrm <br /> CHECK BOX TO EXPEDITE REQUEST-$105 FEE CASH OAR CHECK ONLY)-REQUEST PROCESSED IN AYs <br /> SIGNATURE OF APPLICANT DAT£ C <br /> Electronic Information: ❑ List ❑ Map— Description: r <br /> FILE ADDRESS EHD USE ONLY <br /> Strcat# Street Namc —City - - <br /> _...... _ l- - — --- Ufi�t ' <br /> C�-rA.P. ._ - - b D 6 SG <br /> 3 <br /> 4. ..— .................--------.. ....... <br /> ..._......... -. <br /> 5. <br /> , <br /> 6 <br /> 7. _. <br /> 8. <br /> t ❑ Unit 5 <br /> Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDF.RGROUNrI TANK(LIST)CLEANUP SiTF(LOP) © HOUSING AEiATEMENT SOLID WASTE FACILITY[VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 71 FOOD FACILITY 'WASTE TIRE <br /> UNDERGROUND TANK(MCNETORINGIREMOVAL) CJ DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE Gr NrRATOR 2 CHICKEN RANCH AWASTEVYATER TREATMENT PLANT <br /> TIERED PERMITTED F=AC',LETY 17 MOTEOHOTEL rn PUMPERTRUCK(YARDICHEM TOILETS <br /> O TAT7cofBODY PIERCING 0 POOLISPA LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMrr RECORDS ARE AVAILABLE FOR REyiEW - MONDAY-FRIDAY 8:00 Ara-5:00pw - 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 to (209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses, contact the END. 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$105 deposit prior to review. <br /> EHL? USE ONLY <br /> I <br /> EHD 48-06 8,04'08 --- �_ JBLIC RECORDS RELEASE APP FORM <br />