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j - <br /> T. - D� E3ECEIVED- <br /> I I T <br /> EHD-LQG NUMBER <br /> mm.� ll U J_ AQUIN_COUNTY-- <br /> ENVIRONMENTAL HEALTI3 DEPARTMENT_ <br /> ti' fC09 600 East Main St. Stockton, CA 95202.2708 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.Sjgov.org e ZZ <br /> e 1'tiiF' I IHh T <br /> r-_NV , �P� ;CMN l' 4 Ef;1.I H <br /> 'c `RlifPUlCE PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: AM I fl ord('r BUSINESSIAGENCY: W <br /> ADDRESS:_ �i� 'iUG..tGWGtL a(C6 CITY/STATE/ZIP <br /> PHONE(1): �� S(o`t' y c�y� PHONE(2): }� �u Z� O FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE R/EUEST-$105.00 FEE(CA�FI OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN 5 DATE 3IZ-6&9 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE-ONLY <br /> Street# Street'Name City ❑ Unit 1 <br /> n <br /> (_j- r -1 on+ S+. 5.2 <br /> 2. <br /> ❑ U_nit2 <br /> 3. <br /> 4. Unit 3 <br /> 5. <br /> 6. dOfT Unit 4 <br /> 7. <br /> 8- ❑ Unit 5 <br /> 9. <br /> 4�- ❑ Unit 6 <br /> Specific Date Flange of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 13 SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 11 WASTE Ti RE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 13 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY. 0 MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING 0 POOL/SPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY$;00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to° 209 4640138 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 /> 3:60 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. - - ' I <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$105.00 deposit prior to review. <br /> EHD USE ONLY <br /> '**If you need further assistance please contact Diane Martinez @ (209)468=3425 directly. Thank You*** � <br />