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DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER ENVIRONMENTAL HEALTH DEPARTMENT 1 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd 31 PUBLIC RECORDS RELEA�SE APPLICATION APPLICANT: n(�,��-r- S , �� I C7 jrBUSINESS/AGENCY: ADDRESS: _� c� 7� S pw ( r S q41( . P l /� A PHONE(1): jaUj — a PHONE(2): 29 FACSIMILE: P-0q� TENTATIVE*APPOINTMENT DATE: ' (Please allow 10 business da Time: Ys to of application submittal- Tentative only-must be confirmed) CHECK BOX TO EXPEDITE REQU T 5.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE - / - 0-7 Electronic Information: cKist❑ Map-Description: FILE ADDRESS EHD USE ONLY Street# Street Name City 1. 2 t7 r�1 S Q unit 1 2. 3. 4. ❑ Unit 3 5. 6. Unit 4 7. 8. ❑ Unit 5 9. 10. ❑ Unit 6 Specific Date Range of Information Requested:From to �y ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILrr EHICLE 14 OTHER CLEANUP SITE-(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑DAIRY ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT ❑TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 13 PUMPER TRUCIUYARDlCHEM TOILETS 11 MEDICAL WASTE FACILITY 13 TATTOO/BODY PIERCING ❑POOL/SPA c ,LAND USE APPLICATION SITES 6 OTHER(PLEASE SPECIFY) /M„s / f-/,P- WELL '- WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address Indicated above Address ranges will not be accepted—for additional assistance with file addresses,contact the EHD.Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$95.00 deposit prior to review., EHD USE ONLY