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*Lf <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> 14 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 9868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Tjq�wne: (209)468-3420 Fax: (209).464-0138 Web: www.sjgov.arglehd <br /> ENvPE)%4 ICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: `Z �f�� ,+�` BUSINESS/AGENCY., <br /> ADDRESS: �� G/a-� CITYISTATEIZIP: <br /> PHONE(1):�2Q - s— c�j PHONE (2): FACSIMILE: <br /> TENTATIVE*APPOINTMEN DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST['ROCESSE -J.93-BUSINESS DAYS <br /> �A <br /> SIGNATURE OF APPLI `tVT � ���-- - �s jDDAA'TE 2 ZG <br /> Electronic information: ❑ List[] Map Description: <br /> FILE ADDRESS EHD USE ONLY <br /> i <br /> Street# Street Name City / Unit 1 <br /> �. � zk <br /> 2. d Unit 2 <br /> 3. <br /> 4. -(, / S It] Unit 3 <br /> ave— <br /> Ij Unit4 <br /> • r <br /> 7. <br /> 32 <br /> s. <br /> CI <br /> i �•. � Unit 5 <br /> 9. <br /> 10. <br /> /Unit 6 <br /> Specific!}ate Range of information Requested: From 77Pto Z 2 ! j T <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(HON-LOP) HOUSING ABATEMENT WASTE TIRE <br /> �]UNDERGROUND TANK(MONITORINGIREMOVAL) FOOD FACILITY DAIRY <br /> [�ABOVEGROUND TANK CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY POOLISPA ❑LAND USE APPLICATION SITES <br /> Lj TATTOOBODY PIERCING COMPLAINTIRESPONSE RECORDS ❑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 reviewwill be confirmed approkimately 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 /> i 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$125 deposit prior to review_ ***BOXED AREA_-EHD USE ONLY* <br /> 0 Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 914112 <br />