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DATE RECEIVEDEHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> i <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sw.sjgov.or }>JI <br /> ! PUBLIC RECORDS RELEASE APPLICATION p <br /> APPLICANT: Ll M" <br /> f'- %-�G®.Ft, BUSINES�WA,G/ENCY: CSP" <br /> ADDRESS: L / " e-) /�Z'U (.(`z.^ Sl1''I <br /> PHONE(1): 6 PHONE(2): Vll JQIt ��, < 6 / FACSIMILE:'Ne/1 ;W' L?`�'f�J <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> �/ (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> G CHECK BOX TO EXPEDITE R`E�Q/�IEST-$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTi-�(��,V!-%94 DATE 11 J9Ja7 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Namecity y ❑ nit 1 <br /> 2. ✓��� ? t ✓ f Alp ❑ nit z <br /> 3. <br /> Unit 3 <br /> 4. <br /> 5. <br /> Unit 4 <br /> 8. <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. . . _ ..... __._. FIFOUnit6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 1 , <br /> ; N ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT H SOLID A ITV E? <br /> 18'DTHER CLEANUP SITE(NON-LOP) M FOOD FACILITY ❑WASTE r <br /> WI�N ERGROUND TANK(MONITORING/REMOVAL) E3 DOG KENNEL El DAIRY <br /> M'RAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY 11 MOTELIHOTEL 13 PUMPER TRUCKIYARD/CHEM TOILETS <br /> TATTOOIBODY PIERCING 0 POOL/SPA 17 LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:OOPM - 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD d8-88 WEB &812007 <br />