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I <br />V411V/cVVO 10 . 4e r h A T 16001/001 <br />DATE RECEIVED 46 _ 0 - EHD LOG NUMBER <br />UlfHMSAN <br />JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />FEB 1jI 20ohlephone., (209) 468-3420 Fax; (209) 464-0138 Web- www.sjgovq <br />ENVIRONMENT HEALTH 036 <br />nroiat-rietnInmrn PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: IF;hni-n BUSINESSIAGENCY: <br />ADDRESS: 0-eld Marrnni Aye, 4csu4e� City/Statalzip <br />PHONE (1): PHONE (2): i f9 4 FACSIMILE. <br />TENTATIVE* APPOINTMENT DATE: hrLlQja4 a5 Time: —, 10-A <br />(Please allow 10 business days from date at application Jubmittal -'Tentatw only - must be confirmed) <br />E3 CHECK BOX TO EXPEDITE REQUEST - $105 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />-1-1, DATE 0 <br />SIGNATURE OF APPLICANT rrri <br />Information:Electronic [:1 List [I Map - Description: <br />Specific Date Range of Information Requested: From f4ffArs3caA <br />to C!ugnL <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) Hour,= ABATEMENT <br />OTHER CLEANUP SITE (NON-LFOOD FACILITY <br />OP) <br />#(SOLID WASTE FACILITYIVEHICLE <br />WASTE TIRE <br />3, <br />tKnAIRY <br />(wit <br />UNDERGROUND TANK (momrroRjNWREMOVAL)9�1 Dou KERNEL <br />HAZARDOUS WASTE GENERATOR GL CHICKEN RANCH <br />1OTHER <br />�(WASTEWATER TREATMENT PLANT <br />-1, <br />TIERED PERMITTED FACILITY V- MoTELfHOTEL <br />PUMPER TRUCWYARD/CHEM TOILETS <br />TArroolBooY PIERCING ry- POOLISPA <br />LAND Use APPLICATION SITES <br />MEDICAL WASTE FACILITY0k, (PLEASE SPECIFY) <br />WELLAND Sr;pnc PrLRmrr Rrooftas ARE AVAILABLE FOR RLMFw - MONDAY-FRIE)AY 6:00 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 f20911464-013 or mail to the acidrase 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 (0) <br />days after receipt of application. The files will be hold 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 now 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 some applicant may require a $105 deposit prior to review. <br />EHD USE ONLY <br />