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� SAN JOAQUIN COUNTY EhU LVG NUM13ER <br /> ENVI1wNMENTAL HEALTH DEPARTMEN f <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> Telephone : (209) 468-3420 Fax: (209) 464-0138 Web : www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ZZ� <br /> APPLICANT; _ ��.� T'; nyi�r-er\ m-�rL �..� nc BUSINESSIAGENCY: nn <br /> ADDRESS: - "S C.1clrY arm 1L1 STATE � ry <br /> b � �>,�1 <br /> PHONE (1 ): T-1 0 ^ L f ! S G 9 ) L PHONE (2): FACSIMILE: <br /> TENTATIVE` APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal - 'Tentative only - must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE RE EST - $93.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ti9 V-� DATE t1 A �(7d <br /> Electronic ❑ <br /> Information List 11Map - Description <br /> FILE ADDRESS EHD USE ONLY <br /> Street # Street Name city <br /> 1 . r I � 14-)n N s � �>z <br /> 2. El Unit 1 <br /> its N rRh 1a .n ) + r <br /> 3. CIO r ❑ Unit 2 <br /> 4. <br /> s. .Unit 3 \� <br /> 7. Unit 4- <br /> s. <br /> 9. ❑ Unit 5 <br /> 10. <br /> - F1 Unit 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 FACIUTYNEHICLE <br /> LZ �JHER CLEANUP SITE (NON-LOP) 13 FOOD FACILITY ❑ WASTE TIRE <br /> LIMNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL - ❑ DAIRY <br /> 12111AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND 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 up to ten addresses in the Space above. Select the type(s) of files 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 END 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 behold fora 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. A new <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 /> 1 . <br /> EHD 48 GG <br /> ID/3117006 <br />