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`I i <br /> )ATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> CLI lj, 1J 11z 11U) ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3d)~loor,.Stockton,CA 95202-2708 l(473. <br /> t-w} 2 5 ?, 5' Telephone:(209) 468-3420 lF'ax: (209)464-0138 Wcb: wvnv.sjgov.org/clld <br /> EW'IT1MENTH EALTki PUBLIC RECORDS RELEASE APPLICATION <br /> :. <br /> APPLICANT: <br /> BUSINESS/AGENCY:, <br /> ADDRESS• i✓" 1,.�` `i i. �r.v-L ,J U t l,A g 3 L. _ <br /> PHQNE(1): PHONE(2), .P� kn Z� l s [ _FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE:. ���f IGS Timer <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK Box To ExPEDITE REQUEST-$93 00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z.(Z <br /> _ `` <br /> UNIT DISTRIBUTION M Unit E3 Unit ❑Unit 3 Uni 4—C7'Unit5 ❑ Unite ❑ other(okctronidiistshriaps) 3 <br /> i <br /> FILE ADDRESS 4 EHD USE ONLY <br /> street fl Street Name ;` city <br /> 2. ZL(':'t <br /> 3. 1 14 J cJ- Cr ...� <br /> 4. 5 L1L r Cs 1 1 ✓t= lYL� <br /> 5. ^ 5 14 <br /> 6. Z'7 �� <br /> 7. <br /> S <br /> Dv=clsV • S C <br /> r Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> ��,,,{{R MERGROUND TANK(UST)CLEANUP SITE(LOP) C3 HousiNG ABATEMENT O SOLID WASTE FACILITYl1�EHNXE <br /> rJ <br /> _ 13 OTHER CLEANUP SITE(NON-LOP) ❑FDOD FACILITY M WASM'nR <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) E3 DOG KENNEL 13 DAIRY . <br /> ❑HAzARDous WASTE GENERATOR Q CHLCKEN RANCH 0 EWATERTREATIwEHTPLANT- <br /> ❑TIERED PERMITTED FACILITY C3 MOTELIHOTEL PumPIUIPFRTRUCKIYARDfGHE:N TOSLETS I <br /> 0 TATTOOISODY PIEWNG ❑POOLISPA R LAND USE APPLICATION SITES <br /> I 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERUIT RECORDS ARE AVAILABLE FOR REVIEW• MONOAY4FIaDAY8:00 Am-S-.00PM . EXCLLIDING HOLIDAYS• <br /> S. List up to ten addresses in the space above. Select the.type(s)of tiles from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. Anew <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD 4E-Dx-0G6 <br /> } tn41US <br /> r <br /> a uailb' uen Map d9g:t0 90 � <br /> Z'd 8996-L99 60Z } 8Z qe � <br />