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/7 <br /> DATE RECEIVED EHIStOG NUUkR <br /> % SAN JOAQUIN COUNTY <br /> f �. i ,,� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: 1NWW.sjgov.org1ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 6C BUSINESSIAGENCY: 91/-f14Vj <br /> ADDRESS: 210t_>. 1p /c5c;' CITYISTATE1ZIP6�C-­1,--0, 5-1-e_s-2c, <br /> PHONE(9): qZF-;W,52-'-0_5!?&1PH0NE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> FICHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY�EQUEST PROCESSED IN 3 BUPINESS PAYS <br /> SIGNATURE OF APPLICANT DATE mal <br /> Electronic Information: E] List[] Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City El Unit I <br /> 61 2. El Unit 2 <br /> 3. <br /> 4. <br /> '66nit 3 <br /> 6. <br /> El Unit 4 <br /> 7. <br /> 8. Unit 5 <br /> 9. <br /> 110. 1 El Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> F]UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE <br /> THER CLEANUP SITE(NoN-LOP) El HOUSING ABATEMENT El WASTE TIRE _9 <br /> ❑ <br /> C, <br /> UNDERGROUND TANK(MONITORIN(�rkEWVDAL) Ej FOODFACILITY El DAIRY X <br /> ABOVEGROUND TANK El CHICKEN RANCH/DOG KENNEL El WASTEWATERTREATMENTPLANT 016\ Ao <br /> F]HAZARDOUS WASTEIHAZARDOUS MATERIALS []MOTELIHOTEL E]PUIAPERTRucK/YAFOICHEMICAL TOILETS <br /> F1 TIERED PERMITTED FACILITY [:1 POOLISPA El LAND USE APPLICATION SITES <br /> FITATTODIBODY PIERCING 0 COMPLAINTIRESPONSE RECORDS K OTHER(PLEASE SPECIFY) Pjyz;,'/-4E <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-6:00pm(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 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. '*"BOXED AREA-EHD USE ONLY**` <br /> El Records 'Provided by Staff-PPR Complete. StaffNanle: <br /> EHD 48-06 014112 <br />