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r-' <br /> EHD LOG NUMBER lI <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> i IU 600 East Main St. Stockton, CA 95202-3029 <br /> { `; -„ , .:--;:'T- epFtarte: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.or - <br /> ,Njj T;zoc v i( S PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESSIAGENCY <br /> APPLICANT: : YV' <br /> ADDRESS: r",` 38 u�1��d,++M t� •�: .' CITYISTATEIZIP: <br /> PHONE(1), Iti) PHONE(2): Z2t= +��o FACSIMILE: IQQ t3_, <br /> TENTATIVE*APPOINTMENT DATF' Time: . , <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST- 722 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED I:V10 <br /> NE$$DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information_ ❑List❑ Map—Description: 71 <br /> FILE ADDRESS EHD USE ONLY <br /> Street s Street Name City unit 1 <br /> 1. <br /> 416 <br /> 2.- <br /> 3. <br /> 4 Un1t 3 <br /> 5. <br /> e. Sb3 -'2 4 <br /> ?. <br /> it 5 <br /> [3Unit <br /> 10. Unit 6 <br /> Specft Date Range of Information Requested_ From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSInG ABATEMENT ❑SOLID WASTE FAGILriYNEHICLE <br /> DmrR CLEANUP SITE(NON.LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONDORINGIREMOVAL) ❑DDG KENNEL ❑DAIRY <br /> TO HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOMODY PIERCING ❑POOLISPA ❑LAND usE,APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILM OMER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RiI0RDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:D0PM(EXCLUDING HOLIDAYS) <br /> k <br /> 1. 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 209 464-0i38 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 H any EHD tiles exist An appointment for review will be confirmed approximately tan(110) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br />' S. A file that 15 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 some condition as released will be reorganised by LHD staff at the expense of the applicant. <br /> Future the reviews by the same applicant may require a$722 deposit prior to review. <br /> 1EMD USk ONLY <br /> I <br /> 6m4D48.08 V� u� ;.tir• � , 1 <br /> -,aA `QTl2g�10 <br /> '3'L+ ► �[J4. 1� L } '� t"'`� t•'� �'�I w t;t �M'r 1 � 1.�Ar'{� 'ti1M�l'M� �FNC/ <br />