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' SHIJ LOG NUMBER <br /> �} MIM SAN JOAQUiN COUNTY <br /> fin] ENVIRONMENTAL HEALTH DEPARTMENT <br /> A zOG9 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www sjgnv <br /> EIV`JAWKENT HI EALTH <br /> PE rw VICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ' [ <br /> �` y RU91HE99/A13 <br /> /ENCY: r- i <br /> ADDRESS: 7-10.1 \ 1 �Z�! �jcity/Statellipp) C Q S <br /> PHONE t1): �f�l ✓, _T PHONE(2); 1 V ~ 2--2 L/ FACS ILE Q f <br /> TENTATIVE' APPOINTMENT GATE: A Time; <br /> (Please allow 10 businasa days from Mateof a Ilc i n submittal-*T*ntativa only-must 110 confirmed) <br /> a ❑ CHECK BOX TO EXPEDITE REQU6a E( A5 0 NECK ONLY)-REQUEST PR017 115SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT // DATE ---)2�621 <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> f;treAt>tE Street Name City <br /> -A bAf- l� [7� E] unit <br /> Z- _ f URIC 2 <br /> 4- Unit 3 <br /> G. <br /> 6- <br /> s <br /> Units. <br /> Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FIIrLE$ / �/� <br /> /CUNDURoRouNo TANK(UST)CLEANUP SITE(LOP) 0 HOusiNb ABATEMENT $OLID WASTE FACILITYlVEHICLE lLlb � Lr 1 I1- <br /> 0THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY )eWASTE TIRE /1r <br /> /'etjNDERGROUND TANK(MONITORINWREMOVAL) M COG KENNEL ❑DAIRY <br /> �, FIAZARIDOUS WASTE GENERATDR ❑CHICKEN RANCH ,�...WASTEWATER TRFATMLNT PI,ANT <br /> ,0'nERED PERMITTED FACILITY 0 MOTELIHOTEL lfc+PUMPER TRUCKNAROICHEM TOILETS <br /> ❑TATroo/BODY PIERCING 0 PODLJSPA ❑LAND UsE APPLICATIQN SITES <br /> 'MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WILL AND SEPTIC PERMIT RECORDS ARE AVAILADLE FOR REVIEW - MONDAY-FRIDAY 5.00 AM-6:00PM - EXCLUDING HOLIDAYS. <br /> 1. list up to ten addresses in the space above. SoloCt the type(si)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(208)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 wNl be ptocessed the next business day. <br /> 2. The EHD will notify the applicant if any JEHD files exist. An appointment for review will be confirmed approximately ten(101 <br /> days after receipt of application. The tiles 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EFiQ 48-0 88104/08 PUBUC RECORDS RELEASE APP rQRM <br /> too/lo00 bt9V5[90L0 HVj 81 :6L 6003/90/10 <br />