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EHD LOG NUMBER '�� SAN JOAQUIN COUNTY ��— ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main St. Stockton, CA 95202-3029 Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www,sjgov.org/ehd E.P ViVl� riJ NEI I PUBLIC RECORDS RELEASE APPLICATION C APPLICANT:_76 t � �brlrN BUSINESS/AGENCY:L'IiYneSS�agcsr-I_k tR e..t'-,-, 1. ASP,__ ADDRESS. Tf-etJ t !✓ 3�C_ lV, -7 CITY/STATE/ZIP: r�r,','�. ,9L5"1s70 PHONE(1): �}� !�'�S �t', '�,�+ PHONE (2):-q/� TENTATIVE"APPOINTMENT DATE: Time; (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) ❑ CHECK BOX TQ EXPEDITE REQUEST- 115 FEE(CASH OR CHECK ONLY)-REQUESr PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT • DATE -5 Electronic Information! ❑ Li t❑ Map-Description: FILE ADDRESS EHD USE ONLY Street# Street Name City ❑Unit t 1. Wa46,t, r" Z. C-,T-,� Un!tZ 4. Unit 3 �) 6. Unit 4 I 7. S. ❑units 9. 10. ❑Unit 6 Specific Date Range of Information Requsstcd: From to 1pf,e ENVIRONMENTAL HEALTH DEPARTMENT FILE5 UNDERGROUNo TANK(UST)CLEANUP SITE(LOP) ❑HOUSING A6ATEMENT ❑SOLID WASTE FACILITYIVEHICLE OTHER CLEANUP SITE(NoN•LOP) ❑FOon FACILITY ❑WASTE TIRE UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH []WASTEWATER TREATMENT PLANT ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS ❑TATTOO/BODY PIERCING ❑PODLISPA LAND UsE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORD$AKE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) 1. List up to ten addresses in the apeee above, Select the type(e)of files from the list above by checking the appropriate box(es). At least one the type MUST be selected. Fax to(108)464-0138 or mail to the address indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3.00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately ten(10) days after receipt of application. The alas will be held for a maximum of five business days for review. Appointments should be scheduled accord-ugly. 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file Is available. 4. Any file not returned in the same conation as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$115 deposit prior to review. 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. EHD LIAP ONLY EHD 48-D6 8127109