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/«/LVVti 1s:51 FA), (�j001/001 <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/e Ad .3 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ) J� BUSINESS/AGENCY: <br /> ADDRESS: )� k �U n –� city/State/21p (� <br /> PHONE(1): (a '43-0O PHONE(2):(T)a-- <br /> ` FACSIMILE: <br /> 1_ <br /> TENTATIVE"APPOINTMENT DATE: _ —_ Time: 11 It-� <br /> (Please aliow 10 business days from date of application submittal-"Tontattva only-must be conRrmod) <br /> CHECK BOX TO EXPEDITE RE T- S FEE(CASH O CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS AYs <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List E] Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 1 <br /> 1. N Ir oc��k o n �5` <br /> 2. p�-� + F-� n J 3 Unit 2 r <br /> 3. bci <br /> 4- ��5 N . EI rota Units <br /> 5. �I , <br /> 6. A\ yl Unit 4 <br /> $: Y U s <br /> 9. <br /> Unit 6 <br /> 10. <br /> Speclflc Date Range of Information Requested:From }i`t` o rig c�Q to CU rf , <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERCiROUHD TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) Fool)FACILITY WAST£TIRE <br /> UNDERGROUND TANK(MO NITORINaIREMOVAL) DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MOTELIHOTEL PUMPER TRUCKNARD/CHEM TOILETS <br /> TATTOO/BODY PIERCINGOOLISPA D USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) F��L TI ez <br /> WELL AND SEPTIC PERMrr RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AMd:00PM - 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 appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)46.4-0138 or mai(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 /> 100 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 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 available. <br /> 4. Any file not returned in the some 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$105 deposit prior to review. <br /> EHO USE ONLY <br /> EHD 4"6 8/04/D8 PUBLIC RECORDS RELEASE APP FORM <br />