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© � SAN JOAQU N COUNTY EHD LOG NUMBER <br /> ENVIROM4ENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avcnue,3"d Floor, Stockton,CA 95202-2708 <br /> EWVIROIu%PIENI HEWTKTelephone.-(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd 5"( <br /> PERS Iff/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: (V�AP-) C (W 0 �1 BUSINESSIAGENCY: Q09�_1Wv)21V. WN+SULI- e.� <br /> ADDRESS- L-�� 1 WWS J Id <br /> PHONE(1): L20-Le 3 ::f/ ` LIF`CSIMILE: DD -(/JOS-4141 <br /> TENTATIVE*APPOINTMENT DATE: - e�AA/I Time: V <br /> (Please allow 10 business days from data of application submittal-"Tentative only-must be confirmed) <br /> E3 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH-OR CHECK ONLY)+REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE=OF APPLICANT DATE IVA <br /> UNIT DISTRIBUTION ❑Unit 1 ❑Unit 2 ❑Unit 3 ❑Unit A ❑Unit 5 ❑ Unit IS O Other(elecMonidilstslmaps). <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name city <br /> b� 2 5 <br /> S. 112A 91. tJes t dtj V- <br /> 7. A AW <br /> a. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 16 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E3 HOUsiNa AaAramENT ❑SOLID WASTE FACILITYIVEHK:LE <br /> XOTHER CLEANUP SITE(NON-LOP) ❑Foob FACILITY ❑WAsTE TIRE <br /> h1 UNDERGROUND TANK(MONrrORINOIREMCVAL) ❑DOG KENNEL ®DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WAsTEWATER TREATMENT PLANT <br /> ❑TERED PERmr TED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARD/CHEM TOILETS <br /> d TATTooBODY PIERCING ❑POOLISPA ❑LAID USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERmrr RECORDS ARE AVAILABLE I°OR RWEw- 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mall to the address <br /> Indicated above. Address ranges will not be accepted—for additional assistance with file 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 appilcant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <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. A new <br /> application 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD 4842.008 <br /> 'In+/os <br /> ZOOip) QNYINVO XIUVNOHD TfT1, £99 OTS %Vd 90:fT ZVS 20/6T/TT <br />