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ljj VV I/VV I <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN <br /> I(] F�=C r�=�y <br /> �� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 1. Zt�Q� 600 East Main Street, Stockton, CA 95202-3029 <br /> elephone: (209)468-3420 Fax; (209)464-0138 Web: www.sjgov. <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> � c n�y <br /> APPLICANT: BUSINESSIAGENCY: EI F�rC�iC�I� <br /> ADDRESS; MCS fCc�rl I � Its.C��^�^��City/Strattarzlp ACX CYI � , I <br /> PHONE(1): -l-f O�J � PHONE(�2):` `'kxJl'R0 123 FACSIMILE: �/� , ^ 3 <br /> TENTATIVE*APPOINTMENT DATE: l �hrlAa'b Time: I O-A r'_► - <br /> (Please allow 10 business days from date of application iubmittal-'Tentatfve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �i'��"�c� �5)Q _ DATE R 1 Q'&4o9 <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> T-StrW-9 -1 Street Name city <br /> /10U nit 1 <br /> Unit 2 <br /> 3. <br /> Unit 9 <br /> 5 <br /> unit 4 <br /> s. <br /> 7. nit 5 <br /> 9• nit 8 <br /> 10. <br /> Specific Date Range of Information Requested: From TT 'I o k to Cu- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SrrE(LOP) HOUSING ABATEMENT SOLID WASTE FACILrrYNEHICLE 4 <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY �WASTE TIRE 'Vv <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) DOG KENNEL AIRY <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILrrY MoTEL1HOTEL PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOOIBOOY PIERCING POOLISPA LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RWF_W - 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 milli to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD. Applications received otter <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 now application may be <br /> submitted when the file Is available. <br /> 4. Any file not returned In the same condition as released will be reorganised by EHD staff at the expense of the applicant, <br /> Future file reviews by the some applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> Fun aA-AA Amaroa PUBLIC RECORDS RELEASE APP FORM <br />