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5-20-0E: t9:r28AM:K 1 e; n 4 MOGeSio 2poc�P,.an_: i <br /> EHD LOG NUMBER <br /> )MT74CSAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> c- Tjelephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/e 5 39 <br /> �h PGFi1,ms'-F PPUBLIC CES r <br /> ++ RECORDS RELEASE APPLICATION r _ <br /> APPLICANT: L,iw. % -5�'• <br /> BU <br /> S <br /> IN <br /> ESS/AGENCY: i vi, <br /> ADDRESS: 97 1."'` qlcf' ( 1S 3 > c <br /> PHONE(1): - -` 31JHONE(2): <br /> FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow ten business days from to of application submittal-•Tentative only-must be confirmed) <br /> i7 CHECK BOX TO EXPEDITE REQUEST-$98.0 1 FE CASH OR C�ECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> _ <br /> SIGNATURE OF APPLICANT i Y`I v; kJ';i. ,/ DATE '15 - 1 <br /> Electronic Information: ❑ List❑ Map-Description: _ <br /> FILE ADDRESS EHD USE ONLY <br /> Street it Street Name City ❑Unit 1 <br /> ..2 - ___—__ _ _. __ _ _. _ nit2 <br /> 3. lilliA <br /> 4• nK 3 <br /> 6. <br /> 6- �Un t4 J <br /> 7. <br /> B. �nit 5 <br /> 9. <br /> 10. <br /> ❑ Unit <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> , UNDERGROUND TANK(UST)CLEANUP SITE(LOP) .CI HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> 9OTHER CLEANUP SITE(NON-LOP) CI FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> CrHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ,2r-nERE0 PERMITTED FACILITY ❑MOTEUHOTEL ❑ UMPER TRUCKI'YARD/CHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOUSPA OWLAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 8:09 AM-S: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)464-0138 or mail to the above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> 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 <br /> days after receipt of application. The files will be held for a maximum of rive business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by the EHD staff may not be immediately available for review. A new application <br /> may be submitted when the file is available. <br /> 4. Any Tile 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 49-09 10129IW PUBLIC RECORDS RELEASE APP FORM <br />