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M D , HD LOG NUMBER <br /> ATE RECEIVED <br /> AN JOAQUIN COUNTY <br /> RONMENTAL HEALTH DEPARTMEN <br /> 0 East Main St. Stockton, CA 95202-3029 <br /> Tele�One 209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.or <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: wDak',J TY}y fE BUSINESS/AGENCY: Al mst //V�. <br /> ADDRESS : 2`11�i� � ev5A E& t & ITt�uUie CITYISTATEfZJP : 14%5 >VG7E4N5 Z'+ 9Q62y- <br /> PHONE (1 ): 3 �3 " 9 /Jr ` y� x �/ PHONE (2):Yl,j { CjV " 1 �1 FACSIMILE: 323 - 6jr <br /> TFNTATIVE' APPOINTMENT DATE: Time <br /> (Please allow 10 buslness days from date of application submittal - " Tentativa only = must be confirmed) <br /> I CHECK BOX TO EXPEDITE REQUEST - 15 F (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information : ❑ List ❑ Map — Descrlption : <br /> FILE ADDRESS EHD USE ONLY <br /> Sireet # Str et Name City Unit 1 <br /> 2, ❑ Unit <br /> 3. <br /> Q, nd3 \ <br /> 6, Unit 4 <br /> 7. } m <br /> g- ❑ Unit 6 <br /> 9. <br /> 10. ❑ unit 6 <br /> Specific Data Range of Information Requested: Front <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGRAUNDTANK (LIST) CLEANUP SrrE(LOP) , t] HOUSING ABATEMENT ❑ SOLID WASTE FACILNYWHICLE <br /> OTHERCLLANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br /> UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH ❑r—lI WASTEWATER TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ElMOTFIJHOTEL 0 PUMPER TRUCKIYARDICHEMICAL 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-5:00PM (EXCLUDING HOLIDAYS) <br /> 1 . List un W fen addrp us in the space above. Select the type(s) of files from the list above by checking the appropriate <br /> - box(es). At least one filo type MUST be selected- Fax to 12061464-0136 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 will be processed the next business day. <br /> 2. The EHD will notify the applicant ff any END files exist. An appointment for review will be confirmed approximately ten ( 10) <br /> days after receipt of application- The Nes will he hold fora maximum of five business days for review, Appointments <br /> should be scheduled accordingly. <br /> 3- A file that la actively being worked on by EHD staff may not be Immediately available for review. Anew application may ba <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 $115 deposit prior to review. <br /> S. If you need further assistance, please contact Diane Martinez, at (209) 468-3425. <br /> run USE ONLY <br /> EHD "5 8/27/08 <br />