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DATE RECEIVED EHD LOG NUMBER <br /> �o � iU SAN JOAQUIN COUNTY <br /> ='� <br /> 1 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3d Floor,Stockton,CA 95202-2708 <br /> %005 Telephone:(209)468-3420 Fax:(209)464-0138 Web: www.sjgov.org/ehd <br /> 11q15 <br /> hLALTN PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: A[1GLsM 11(cnan c BUSINESSIAGENCY: C`�IG�L 1 'may �G(o O /Vicci <br /> `C ] <br /> ADDRESS: rrI Iy S (� �G•- LIr1C{G�_ ] }'c__oZ LI lf+S ff0.1C� lzsi <br /> PHONE(1): lq ZaO)SS I—I a t04 t-I PHONE(2): FACSIMILE: t J d)\\ by sl-3 4 7 8 <br /> TENTATIVE*APPOINTMENT DATE: Ting: <br /> (Please allow 10 business days from date of application submittal-'Tentoffm only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$93.100 FEE n(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 11 t�7r[JI o ,.,� DATE Cj a b <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Unit 3 ❑Unit 4 0 Unit 5 ❑ Unit 6 ❑ Other(electroniclistshnaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name City <br /> 7. 1 5 <br /> 2- r-1 '-N <br /> 4. <br /> 6. <br /> 7. , <br /> 8. <br /> 9. <br /> Specific Date Flange of Information Requested:From to C-r) <br /> ,,., <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> XUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILRY/VEHICLE <br /> OTHER CLEANUP SITE(14ON4-OP) ❑FOOD FACJLrrY ❑WASTE TIRE <br /> UNDERC.ROUNDTANK(tADNrrORNG1RFucvvAL) ❑DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCN ❑WASTEWATER TREATMENT PLANT <br /> Q TERED PERMnTED FACILITY ❑MOTELIHOTEL ❑PumPERTRUCK/YARD/CHEMToa_ETS <br /> ❑TATTOO/BOOY PIERCING 0 POOLISPA ❑LAND USE APPLICATTON SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECFI� <br /> WELL AND SEPTIC PERIArT RECORDS ARE AVAILABLE FOR REYIEw - MONDAY-FRIDAY 6:00 AN-5:00PM - EXCLUDNG 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to 12091464-0138 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(10)days after receipt of application. The files will be field for a maximum of five business <br /> days for 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 deposit prior to review. <br /> END u-024N <br /> euros <br /> L'd at'E-l9t, (08b) d06:Z1 50 OZ deS <br />