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f <br />Paul Humphrey, REA, CAC 559- 6-3408 p.1 <br />DATE RECEIVED EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />.10 Z011Z Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.orglehd <br />E pLTir# <br />ERMITIIS RVIGES <br />PUBLIC <br />�RECORDS RELEASE APPLICATION <br />APPLICANT: &Z f7/�w�n� I BUSINESS/AGENCY: <br />ADDRESS: 7d-/0-2- CITYISTATEIZIP: &-esyo L"A 93-7-37 <br />PHONE (1):S PHONE (2): FACSIMILE: <br />TENTA77VE' APPOINTMENT 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 PROCESSED IN 3 BUSINESS DAYS <br />SIG/NA URE OF APPLICANT DATE <br />Electronic information: ❑ List ❑ Map - Description: <br />9. <br />10. <br />Specific Date Range of Information Requested: From <br />AAII <br />�/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />�/ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT <br />❑ OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />[UNDERGROUND TANK (MONITORINGIREMOVAL)01, <br />❑ DOG KENNEL <br />❑ HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ TIERED PERMITTED FACILITY <br />, <br />❑TATIOOIBODYPIERCING <br />9. <br />10. <br />Specific Date Range of Information Requested: From <br />AAII <br />�/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />�/ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT <br />❑ OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />[UNDERGROUND TANK (MONITORINGIREMOVAL)01, <br />❑ DOG KENNEL <br />❑ HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ TIERED PERMITTED FACILITY <br />❑ MOTELIHOTEL <br />❑TATIOOIBODYPIERCING <br />❑ POOLISPA <br />❑ MEDICAL WASTE FACILffY <br />[I COMPLAINT RECORDS <br />❑ Unit 6j <br />_ to <br />❑ SOLID WASTE FACILITYNEHICLE <br />❑ WASTE TIRE <br />❑ DAIRY <br />❑ WASTEWATER TREATMENT PLANT <br />❑ PUMPER TRUCKIYARDiCHEMICAL TOILETS <br />❑ 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 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 behold 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 $125 deposit prior to review. <br />t ' ! t <br />Received Time ]`u n, 6, 2012 10:23AM No. 0 10 1 ffW fie—Rr'GOl ."M <br />