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DATE RECEIVED NOW SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> (-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St, Stockton..CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (.209) 464-0138 Web: vvmv.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; C_-2-/�_- r-G BUSINESS/AGENCY: adv 77 Z= <br /> ADDRESS: CITYISTATEIZIP: LSCA L_�'' C-4 / 33 �10 <br /> PHONE (1): PHONE (2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from dale of application submittal-'Tenfafive only-must be confirmed) <br /> ❑ CHECK BOX TO EY,PEDITE REQUES LY)-REQUEST PROCESSED!N 3 B NE Si <br /> DAYS <br /> SIGNATURE OF APPLICAN (C�0' <br /> -DATE <br /> _ <br /> Electronic Information: ❑ List ❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> SV013tt# Street Name City <br /> 1.— [ 3 D� G�? N � �. — ❑UnR1 <br /> 2. <br /> f7 <br /> 3. -- ❑ Unit z <br /> - <br /> 5. lj Unit 3 <br /> rt t 4 <br /> 7. <br /> 9. - - — -- ❑Unit 5 <br /> i0. <br /> 0 unit b <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILETS RC1 <br /> gOTHER <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSItdG ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WAsTETIRE <br /> NDERGROUND TANK(MONITORINGIREMDVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL <br /> ❑PUMPER TRUCKIYARDICHEMICALTOlLETS <br /> ❑TATTOOII30t)Y PIERCING ❑POOLJSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARI;AVAILABLE FOR REvm: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> I. List up to len 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 209 464.11136 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 he processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD tiles 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 $122 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 <br /> 07!29!1 o <br /> i <br />