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DATE RECEIVEDHD LOG NUMBER <br /> AN JOAQUIN COUNTY <br /> . r � ONMENTAL HEALTH DEPARTMEN <br /> V4 600 East Main St. Stockton, CA 95202-3029 <br /> Tel@Ofione: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.or <br /> 1 PUBLIC RECORDS RELEASE APPLICATION <br /> }{ <br /> APPLICANT: wDaoryJ l?"C'us BUSINESS/AGENCY: /rq(( Apjd( o:5 004 hs, /iVG, <br /> ADDRESS: 60� fwv it E'& /T1�e_NUE CITYISTATE2IP: "-e 4ff6-7EGE3,z+ 96o2.: <br /> PHONE(1): y/f` �{a �/ PHONE(2):",tom, t4 t 101} FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time. <br /> (Please allow 10 business days from date of application submhtal-"7ontafive only-must be confimted) <br /> 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—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name City Unit 1 <br /> 1. 15r 7-t <br /> 2. <br /> ❑Unit 2 <br /> 3. <br /> 4' nit 3 \ <br /> 6. <br /> 6. <br /> Unk4 <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> El <br /> 10. <br /> Unit 8 <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 9UNDERGROUND TANK(UST)CLEANUP SHE'(LOP), L]HOUSING ABATEMENT ❑SOLID WASTE FACILIYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONrTORINGIREMOvAL) ❑DOG KENNEL ❑DAIRY <br /> HAzARuous WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEJHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> 0 TATTOOIBODY PIERCING Q POOLISPA ❑LAND USE APPLICATION SITES <br /> [] MEDICAL WASTE FACILHY ©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 t(p to ten addrysses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). Atleast one file type MUST be selected. Fax to(2091464-0138 or mail to the address indicated above Address <br /> ranges will not be accepted-for additional assist 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 If any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application- The Hies 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 available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHL)staff at the expanse of the applicant. <br /> Future file reviews by the same applicant may require a$115 deposit priorto review. <br /> 5. If you need further assistance, please contact Diane Martinez,at(209)488-3425. <br /> END USE ONLY <br /> EHD 4808 <br /> 8727109 <br />