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CEIVED EHD LOG NUMBER <br /> DATER & <br /> SAN JOAQUIN COUNTY !FE <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> � ( SLL <br /> 1668 East Hazelton Avenue, Stockton, CA 95205-6232 ) <br /> Telephone: (209) 458-3420 Fax: (209) 464- w <br /> 0138 Web: ww.sjgov.org/ehd ) <br /> PPUBL,IC\ RECORDS RELEASE APPLICATION / n <br /> APPLICANT: � , � 4Es -r, yr_� BUSINESSiAGENCY: CEAyRAL VAa uLt u9fnot YY "x <br /> ADDRESS: 2�5� lA) `� • 1+R'< LI, GA) CITYiSTATEiZIP: S�eXKaipCA <br /> �1� lct <br /> PHONE (1): �jt{LI — 7�3 PHONE (2): 'i? " i4I0 FACSIMILE: t Gp " q(955 <br /> TENTATIVE' APPOINTMENT D Time: <br /> (Please allow 10 6uslneas d fr m date of app cation submittal - 'Tentative only - mint be confirmed) <br /> ❑ CHECK ROX TO EXPEDITE REQ ST- 1 F2 �AS CHECK ONLY) - REQUEST PROCESSED IN 3 BU NES DAYS <br /> SIGNATURE OF APPLICANT DATE 17 13 <br /> Electronic information: ❑ List ❑ Map —, Description: <br /> FILE ADDRESS END USE ONLY <br /> street M Street Name rr City aUnit 1 <br /> 2, unit <br /> 3 <br /> 4. h' /Q. C (3Ae ICJ Ubit3 <br /> l Er6nit4 <br /> 7. <br /> 8IajC; El Unit 6 <br /> l <br /> s. <br /> 10 Q Unit a <br /> Specific Date Range of Infennation Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUNii TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILnYNEHICLE <br /> JABOVEOROUND <br /> THER CLEANUP SITE (NON•LOP) ❑ HOUSING ABATEMENT WASTE TIRE <br /> NtlERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br /> TANKE] CHICKEN RANCH( DOG KENNEL ❑ WASTEWATERTREATMENT PLANT <br /> AZARDOUS WASTEiHAZARDOUS MATERIALS ❑ MOTELiHOTEL PUMPERTRUCKIYARDICHEMICALTOILETS <br /> IERED PERMITTED FACILITY ❑ POOLiSPA ❑ LAND USEAPPLICATION SITES <br /> ❑ TATTOOIBOOY PIERCING E] COMPLAINTiRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type($) of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to (208) 464.6138 or mail to the address Indicated above. Address <br /> ranges will not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after <br /> 3.60 pm will he processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be Immediately available for review. A new application may be <br /> submitted when the file Is avallable. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a S12S deposit prior to review. `±'BpXEtTA4 >rHOtt$ CNLV <br /> Records provided':ey Staff-PPR-`Gamolete. 5w(rHamBi . <br /> aiur2 <br /> EHD Aa-06 <br />