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DATE RECEIVED /+ <br /> .�� SAN JOA.QUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> CIRTelephone, (209) 468-3420 Fax; (209)464-0138 Web:www.Sjgov,o <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> BUS <br /> INE33/AGENCY: G- <br /> ADDRESS: �j2 p v <br /> PHONE(1): !3 7 <br /> PHONE(x); FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: og Time: <br /> (Please allow ten business days from data 6f Qppllcatlon submittal-•Tentative only.must be confirmed) <br /> ❑ CHECK 13OX TO EXPEDITE REQUEST-$98.00 FEE(CASH OR CH K ONLY)-REQUEST PROCESSED IN THREESINESS DAYS <br /> SIGNATURE OF APPLICANT /�-42441-12, <br /> + ,1 L . ,�rT DATE <br /> Electronic Information; ❑List❑ Map-Aescription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> e-2 906 ❑Unit1 <br /> 2. <br /> ❑Unite <br /> 3. <br /> 4. tMUnit <br /> 8. <br /> 6. <br /> T.9.10 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 'NDERGROUPID TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT p <br /> THER CLEANUP SrrE(NON-LOP SOLID WASTE FACILITrNEHICLE <br /> LITY <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KE KFACENNEL CI WASTE TIRE <br /> HAZARDOUS WASTE GENERATOR ©DAIRY <br /> TIERED PERMITTED FACILITY CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TATTOO/RonY PIERCINGMOTELIHOTEL 17 PUMPER TRUCKIYARDICHEM TOILETS <br /> EDIGAI WAST FACILITY <br /> M POOL/SPA Q LAND USE APpuCATION SITES <br /> 1�+�+ 0 OTHER(PLEASE SPECIFY) <br /> / WELL AND SEPTIC PERMIT RECORDS ARE AvAiLAixc FOR REVIEW- MONDAY-FRIDAY 8'00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2p9)464-0138 0r mail to <br /> not be accepted-for additional assistance with file addresses,contact the RHD.App ica{ons received after 3:00 pm wi�ove ad�drepp. Address ranges ll <br /> 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 <br /> days after receipt of application. The flies 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 the EHD staff may not be Immediately available for review. A new application <br /> 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 applicant. <br /> Future file revlews by the same applicant may require a$98,00 deposit prior to review. <br /> EHD USE ONLY <br /> EMD 46-06 f Z®IaT <br /> P 9UC RECORD RELEASE APP F RM <br />