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L�! �C� <br /> DATE RECEIVED EHD LOG NUMBER <br /> JUN 1 Q Zoic SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENU(Rof r4� 1;��T HEALI} CA 96202-3029 <br /> 600 East Main St, Stockton, <br /> e'rr-A'f oPERMIT1SERV(C lephone: (209)4683420 Fax: (209)464-0138 Web: www.sjgov.org/ hd <br /> �ti"OGBLIC RECORDS RELEASE APPLICATION <br /> - PLICATIpN <br /> APPLICANT: �, tf1'f BUSINESS/AGENCY: <br /> ADDRESS: �(��d u r- (k J. <br /> CITY/STATE21P: <br /> PHONE(9): 016 97T- 9900 PHONE(2):Fa`X' K 16 <br /> 9 73�1--640F'ACSIMILE: <br /> TENTAT/VE*APPOINTMENT DATE: Time: <br /> (please allow 10 business days from date of appllcatlo submittal-"Tentative only.-Must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUFEE ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> QS $1 <br /> SIGNATURE OF APPLICANT /may DATE � J DD l0 <br /> Electronic Information: ❑List El Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> t 1 <br /> 2. II � � n <br /> 3.5. 4Unit3 <br /> 4. <br /> 7. <br /> 8. <br /> Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific hate Range of Information Requested: From to 0 <br /> ENVIRONM5NTAL HEALTH 1ARTMENT FILES <br /> UNDERGROUND TANK(US))CLEANUP SITE(LOP) C]HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> C,UNDERGROUND TANK(MONITORINGIREMOVAL <br /> ) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR Cl CHICKEN RANCH <br /> )�TIERED PERMITTED FACILITY ❑MOTELIHOTEL El Q WASTEWATER TREATMENT PLANT <br /> ❑❑TATTOO/BODY PIERCING ❑POOLISPA PUMPER TRUCKICARSITES <br /> MEDICAL WASTE FACILITY gL TOILETS LAND USE APPLICATION SITES <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW; MONDAY-FRIDAY$:00 AM-5:00PM(EXCLUDING HOLIDAY$) <br /> 1. List up to ten addr��ses In the space above. Select the type($)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fdx 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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)4683425, <br /> LitEMD USE QryLY <br /> EHD"_06 <br /> BIW71pp <br /> TO/TO 30Vd DNI -1VH1N3S0d 83GN3E t;06b8L69TG TT:VT OTOZ/OT/90 <br />