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SAN JOAQUIN COUNTY <br /> ENVY--w.JNMENTAL HEALTH DEPARTN#%"IT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95--2-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd , <br /> f PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: F 6 L cG BUSINESS/AGENCY:_ <br /> WL(Ja��ace- <br /> ADDRESS: -5ij)t) . �'1a'^µ"er AML Sitii}Z F S}>,r0m 6A <br /> PHONE(1): 201- 7-54-"7?Z-2, PHONE(2): FACSIMILE: ZOq-23q-- 772 7 <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 REQU -593.00 F E H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Vz.-� � —DATE -7 f 3 <br /> UNIT DISTRIBUTION ❑ Unit 1 0 Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 0 Other(electronicllists/maps) <br /> FILE ADDRESS <br /> Street# Street Name Cid, HD USE ONLY <br /> 1. O Lowt +ZIG k <br /> 2. ; k <br /> 3. - <br /> 4. <br /> 5. - — <br /> 6. <br /> 7. - <br /> 9. <br /> 8.. -- <br /> Specific Date Range of Information Requested: From to e.c.¢.^ <br /> ENVIRMM- NTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> /001 <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 6:00 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 <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 (10) days after receipt of application. The files will be held 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 /> r <br /> .K 1 <br /> EHD 48-06 <br /> 1/14105 <br />