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JU1 - 16-07 03razand Assoc 559 2190 P . 01 <br /> DATE RECEIVED SAN JOAQUIN COUNTY ` <br /> �0, ENVIRONMENTAL HEALTH DEPARTMENT <br /> L304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> S f C14KTelephone: (209)468-3420 Fax: (209)464-0138 web:www.9jgov.org1chd <br /> PUBLIC RECORDS RELEASE APPLICATION _ <br /> • � �-• SUSINESSIAGENCY: Z� <br /> APPLICANT' <br /> 9r / I C_ fL �" tg--1'1c�Lf.iii CITY da STATE <br /> ADDRESS- FACSIMILE �y`j1_� <br /> . .,fes _ d 11I PHONE(3): <br /> PHONE(1k� .. <br /> Time: <br /> TENTATIVEAPPOINTMENT DATE: mutt!M coRemted) <br /> (Please 211oW 10 busin"s days from data Dt aPPllcatlon 9ubmieal••Tentative Dnly- <br /> C] CHECK SOX TO EXPEDITE REQU -$93.00 FEE(CASH OR CHECK ONLY)-REQUES DASS�ED IN 3 BUSIN S DA <br /> SIGNATURE OF APP 'ICANT <br /> Ebetron:c D Lilt O Mop-D FI CAP" <br /> Information <br /> FILE ADDRESS EHD USE ONLY <br /> Street Name city <br /> seT..re ❑ Unit 1 <br /> 2, ❑ Unit 2 <br /> 3' Unit 3 <br /> 5.- Unit 4 yd�1 <br /> s. <br /> 7. ❑ Unit 5 <br /> e. <br /> g, — ❑ Unit 6 <br /> 10. <br /> Specific Date Range of btfom stion Requested:From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑HOUDINOARATEMENT O SOLID WASTE FACWTY1VVH4LE <br /> UNpERGRDUND TANK[UST)CLEANUP SITE{LOP) O FOOD FACILITY O WASTE TiRe <br /> O OTHER CLEANUP SITE(NON-LOP) O IDDa KENNEL O DAIRY <br /> `Lp UNDERGRoUND TANK(MONROmNOIREMOVAL) 0Des CHICKEN RANCH In WASTEWATER TREATMENT PLANT <br /> Y�HAZARDOUS WASTE GENERATOR 0CHICEN RAN ❑ PUMPER TRUCNJYAeDIGHEMICAL TOILET$ <br /> TIERED PERWTTED FACILITY rn CI POOLfSPA M LAND Use APPL;tATI011 SITES <br /> O TATTOOIBCDY PIERCING OTHER(PLEASE SPECIFY) <br /> O MEDICAL WASTE FACILITY <br /> WELL AND SEPTIC PERMIT RyCORDa ARE AV aLe.FOR REVIEW-MONDAY-FRICAY 0:00 AM-6:00PM - EXCLUDING OLI A <br /> 1. List up <br /> to ten addresses in the space above. Select the types)of flies from the list above by checking the <br /> appropriate box(eS). At least one file type MUST be selected. Fax to 1209)464-0138—or mNl to thea rags <br /> IWKatpd above. Address tangos will not be accepted-for additional assietsnce with fila 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 The fees oint lent held toe will be confirmed <br /> flue business <br /> approximately ten (10) days after receipt of app <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. Anew <br /> application may be Submitted when the file is available. of the <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior t0 review. <br /> EHD 4$4c <br /> IWiNteea <br />