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cnu LV V Iv V IVltictt <br /> V y SAN JOAQUIN COUNTY <br /> ENvbaNMENTAL HEALTH DEPARTIONT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.Sjgov.org/ehd <br /> 2000 <br /> /� 1 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: - �7 BUS`IN/ESSIAG(ENCY:/ SSca,Ci <br /> ADDRESS: 10. ..�G.a/✓ccGCc-L (�l �+Pte'�1 r " N` jk &/f-)- / ;—L2- <br /> PHONE(1): 3`77-5?G6& PHONE(2): FACSIMILE:Lf(.3 24 6/a Z-o <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 REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 B SINESS DAYS <br /> SI ATURE OF APPLICANT �/ DATE 7 << 6 0 <br /> UNIT DISTRIBUTION ❑ Unit 1 -❑ Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 ❑ Other(electronicllistslmaps) <br /> FILE ADDRESS EHD E ONLY <br /> Street# Street Name City <br /> r4._2 <br /> � 2 v N d. �)r <br /> T. c2 FF" <br /> 9. .F <br /> 10. -),2k I Ate. - N <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT )1 SOLID WASTE FACILITYNEHICLE / <br /> THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑PUMPER TRUCKIYARD/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 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 <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 /> EHD 4"6 <br /> 1114105 <br />