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EHD LOG NUMBER <br /> � ED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> `s QQJO 600 East Main St. StoCkton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)404-0138 Web: www.sjgov.o Id <br /> EC�1'i«ui`�Tfitl'�i !3ETfi PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: o •��� n,r .n BUSINESS/AGENCY!{ �,c <br /> ADDRESS: fafC-m-, Ave. CITY/STATE/ZIP: S,4,a,-ejg <br /> PHONE(1): O D PHONE(2): FACSIMILE: 16 q50 r,Q <br /> TENTATIVE"APPOINTMENT DATE: AgAQ Time: <br /> (Please allow 10 business days from date of application submittal-"Tentattve only-must be confirmodY <br /> ❑ CHECK BOX TO EXPEDITE REQ -$ $FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> EST <br /> SIGNATURE OF APPLICANT DATE/J-a),611 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> /. <br /> 2. L`�1� ` f ;., nit2 <br /> 3. <br /> 4. nk3 `\ <br /> 641, <br /> 5. <br /> r7. <br /> Init <br /> ❑Unit S <br /> 10. nit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLL 0,5 <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE �l <br /> NDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL LIMPER TRUCKNARD/CHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List un to ten addreases 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. (2091464-0138 or mall to She address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications recelved 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 flis reviews by the same applicant may require a$115 deposit prior to review. <br /> 5. H you need further assistance,please contact Diane Martinez,at(209)4684425. <br /> EHD use ONLY <br /> EHD 4846 927M <br /> L00/L00z XUA LZ 80 BOO2/iZ/OL <br />