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thu LUU NumbtK <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> D� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 E <br /> OiNR � elephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> '/ <br /> \0 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> _ / r- � , <br /> APPLICANT: i� L� 3 F 1.�BUSINESS/AGENCY: <br /> rn ESS/AGENCY: l-[,S , <br /> ADDRESS: �S S C-0 Pj Dy �` �: D RTE 7F� - o <br /> PHONE(1): 5 1 S��L�{�ZZ—__.PHONE(2):=s I� 7 y�t q�J�( o b FACSIMILE: -S-1 D -7 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business d ys from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQ ES -$ <br /> 9 00 F CASH OR CHECK ONLY)-REQUEST PROCESSED IN 33 BUS ESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑ Unit 1 nit 2 nit nit ❑ Unit 5____F_ 13Unit 6 13 Other(electronic/lists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 2. -3 ' r"�l I <br /> 3.4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. G F- , <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 11HOUSING ABATEMENT El SOLID WASTE FACILITYNEHICLE <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 FOOD FACILITY ❑WASTE TIRE <br /> OTHER CLEANUP SITE(NON-LOP) ❑DOG KENNEL ❑DAIRY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑CHICKEN RANCH ❑WASTEtR <br /> MENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑MOTEL/HOTEL ❑PUMPE /CHEM TO S <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND UN SITE <br /> ❑TATTOOIBODY PIERCING❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:OO <br /> LIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files f 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 <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 (I o)days after <br /> receipt <br /> of scheduled application. Thefiles ingtywill be held for a maximum of five business <br /> days for review. Appointments <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 deposit prior to review. <br /> Ij:— <br /> EHD 48-02-006 <br /> 11/23/04 <br />