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DATPWDIVED-N-� aJ,. EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ��. z;�=�Wit.•.. ,�, ��. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUL 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> s_.ilt r; Mt_NTil, ).3 i Lq.I <br /> ;r PUBLIC RECORDS RELEASE APPLICATIOf ILE Copy <br /> APPLICANT: �`z .,,.,/1�1� Cln, v�-C,1�1� BUSINESS/AGENCY: <br /> ADDRESS: � ��, S, ������ CITY/STATE/ZIP: C <br /> PHONE(1): ()9 q:�k_ PHONE(2)ta(1,r FACSIMILE�{�,(1j q 6j a .� 1 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST125 FE (CAS OR ECK 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 /> 2. OW3 43D v-- ❑ Unit 2 <br /> 3. <br /> 4. i Unit 3 <br /> 5. <br /> 6. Unit 4 <br /> 7. <br /> 8. J211nit 5 <br /> 9. <br /> 10. .-E1 =t6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES _ <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLEgo �� <br /> OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT ',WASTE TIRE e-4'4 <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> rn ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> .HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> rXj TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING 'f��COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the types)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 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 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 ^ y.ile4iot retufned-in4he-same-rendition-as released-will-be-eorga+sized4ay-E-10.sta#at t e-expeoseef-tfte-applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 914112 <br />