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U!/1u/GUUt1 10:04 VAA QJ 001 <br /> _DATE RECEIVE EHD LOG NUMBER <br /> � SAN .IOAQUIN COUNTY <br /> L�' ENVIRONMENTAL HEALTH DEPARTMENT <br /> IA ZO�Q 600 East Main Street, Stockton, CA 95202-3029 _ Iw72, <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org <br /> [-NM 01NME1 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 -t Y ll / I BUSINESS/AGENCY: 1-.E l(oN'I'D j (DMS IALTtNG <br /> ADDRESS: _ I t , I ,tC,,nwo0i City/State/Zip {�!1}�} �� g1-(OIi <br /> PHONE(1): q�La$I-- T/-S7 PHONE(2): cf 4q-354-13ob FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: 'T'2I-0 q Ti.,. <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be onfirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �✓ DATE 7-/1i-14 <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ <br /> 1 Unit 1 <br /> Inl. 1,with fYCa <br /> 2' 2 12-2 1j, ti{n e( ❑ Unit 2 <br /> 3. -74 N. U4:ex l2Oc — <br /> Unit 3 <br /> 4. 3 0� S 'I•' 3-5 Ij <br /> I q W t Unit 4 <br /> 6. <br /> 7. <br /> Unit 5 <br /> 8. <br /> 9. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From !h a%q!&4 to Ar a <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEL/HOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - 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 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. Any file 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$106 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />