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- -- SAN JOAQUIN COUNTY f-RECOVEDE{ 11RONMENTAL HEALTH D EPA.RENT <br /> ` 344 East Weber Avenue, 3 Floor, Stockton,CA 95202-2708 <br /> .lUL 2005 Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/chd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: © R �7C1 BUSiNESSIAGENCY: VN�Y�I <br /> ADDRESS: <br /> PHONE(1):- _01 —7 I Z—Y:Z! (V PHONE(2): FACSIMILE: Z-03 " 7 59 150-70 . <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> E3 CHECK BOX TO EXPEDITE RYfiEST.$93.00 FEE(C S OR CHECK ONLY)..REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE '` 19 17 <br /> UNIT DISTRIBUTION ❑ Unit 1 0Uidt 2 t 3 O Unit 4 hJJnit 6 13 Unit 6 ❑ Other(electronicAls-tstmaps) <br /> FILE ADDRESS EHD,USE ONLY <br /> Street# Street Name city <br /> tA) 12125F( <br /> 2. z3� <br /> F3. �{ <br /> 4. <br /> 5. cl 5 pdort <br /> 6. <br /> 7. <br /> 8. <br /> Specific Date Range of information Requested:From 50 to e 5e- : <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> R.UNDERCROUND TANK(UST)CLEANUP&ITE(LOP) ❑HOUSING ABATEMENT O SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FAGILRY, ❑WASTE TIRE <br /> "F UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> :'HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEATER TREATMENT PLANT <br /> ❑TIERED PERMnTED FACILITY ❑MOTELIHOTEL E3 PUMPER TRUCK/YARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILnY - ❑OTHER(PLEASE SPEasWELL AND SEPTIC PERMIT RscoRDs ARE AVA.R.ABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:OOPMC - ExcLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select thetypes)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 i <br /> the EHD.Applications received after 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 <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business : <br /> clays foir 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 depositprior to review. <br /> - I <br /> n \fin <br /> EHD a-02-006 <br /> 11f23M <br /> h <br />