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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY � _� _ <br /> ` ENVONMENTAL HEALTH DEPARTM T �, <br /> L �'`�-�" <br /> 600 East Main St. Stockton, CA 95202-2708 <br /> T.e31ephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/eh <br /> 'PUBLIC RECORDS RELEASE APPLICATION <br /> API �k( 4��' Z'L�U/Q! <br /> Cay � c �USINESSIhGENCY:� v4e- ke <br /> ADDRM: lJ, &oa jj_rJW0: �3G <br /> PHONE (1): 00k_ �Lr -Z�SPE �Z <br /> y ' <br /> TENTATIVE*APPOINTMENT DAT <br /> C. <br /> Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$115.00 FEE(CAS R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: <br /> � ❑ L' ap—Description: <br /> b <br /> FILE ADDRESS Zgc, EHD USE ONLY,t <br /> Street# Street Name City /'9 <br /> /JP Unit 1 <br /> J 1. 2 Z/D 3 <br /> 2' b 3 "a i"- 14ve. <br /> -73,2,u, ej-, Unit 2 l <br /> 3. <br /> 2-301 <br /> 4. <br /> 5. Unit 3 <br /> 7. - , nit 4 <br /> 8. <br /> --- ❑Unit 5 <br /> 9. <br /> 10. 00 <br /> nit 6 <br /> Specific Date Range of Information Requested: From 420 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> O UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE, ` <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ®WASTE TIRE (� <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL <br /> HAZARDOUS WASTE GENERATOR ❑DAIRY <br /> ❑CHICKEN RANCH �S ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILrrY y^ <br /> ❑MOTELIHOT oJG� �'+ l ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING POOLISPA � Ca�a LAND USE APPLICATION SITES <br /> to MEDICAL WASTE FACILITY OTHER(PLEASE SPECIF 7 r <br /> WELL AND PEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW 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 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 be held 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$115.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance please contact Diane Martinez direct) @ (209)468-3425. Thank You*** <br /> 1 FNn aa_na = <br /> an»nno <br />