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' I CELVE EHD LOG NUMBERSAN JOAQUIN COUNTY <br /> +41, lj 7-012 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRO14MENTALI-IEAI:I-ITelephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sjcgay.orcg/eI­Id <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: V/06e /--h GfO BUSINESSIAGENCY: y- Dov,-cr <br /> ADDRESS: 213L'bodzCITYIS ATEIZIP: f btv'j(Ck of 0"r, 2 <br /> PHONE(1): (2L f0 9Pff`3 i 7., PHONE(?-): el) �Iq-/10 cad,1175 FACSIMILE: (26 co En/'q' <br /> TENTATIVE*APPOINTMENT DATE: 4 �r)P Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE RFQUFST-$125 FEE(CASH R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ;� t�' � DATE _T1 /- J <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street name City ❑Unit 1 <br /> 1. Loile Tree <br /> 2. Unit 2 <br /> 4. Ed 00-3 ❑Unit <br /> 6. ❑Unit4 <br /> T. <br /> %Y*Please respond as soon as possible. <br /> I need to notify applicant during week of 5/14/12 if <br /> 3' EHD has files for listed addresses or not. —❑units <br /> 9. <br /> 0. ❑ Unit 6 <br /> Specific Date Range of Information Requested: From 2 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SIT E(LDP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑COG KENNEL %( DAIRY SHC <br /> ❑HAZARDOUS WASTE OENEP.ATOR ❑CHICKEN RANCH ❑WAST EWAT ER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑C IOTELMOTEL ❑PUMPER TRUCKIYARDICHEM{CALTOILETS <br /> ❑I ATTOOISODY PIERCING ❑P OOUSPA ❑I-AND USE APPLICAT:ON SITES <br /> ❑ MEDICALWASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW. MONDAY-FRIDAY 00:00 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 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 EI-11]. 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%rill 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,�; <br /> ergo ao-es <br />