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DATE RECEIVEDw tr1U LUti NUMbLK <br /> ,*.V SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPAR"edENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468.3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd5 <br /> PUBLIC RECORDS RELEASE APPLICATION n'^ <br /> APPLICANT: C k VY�.4 BUSINESSI�AtGENCY:t1/1_t_� W bYDD S �i 1V�►�1n�1Qt <br /> ADDRESS: 5 W • Il S'QQ,�- , �. C Pr- 'IA bG t _ <br /> PHONE(1): SI o —Sa 1 --D Q q 'a' T_PHONE(2).11q — 345 —9961pFACSIMILE: 5ko- 99 1 -p 013 <br /> Lai130T <br /> TENTATIVE*APPOINTMENT DATE: Q 1 _Time: 1d� <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> HECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE *2>10 S <br /> UNIT DISTRIBUTION ❑ Unit 1 It 2 nit 3 nit 4 ❑ Unit 5 qKUnit 6 ❑ Other(electroniclliststmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 2. w, <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY/VEHICLE <br /> EX OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY }$.WASTE TIRE <br /> 13�,UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 13 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR <br /> TIERED PERMITTED FACILITY 11MOTELIHOTEL ❑ PUMPER TRucKIYARDICHEM TOILETS <br /> d TATTOOIBODY PIERCING ❑POOLISPA .QA LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:OOPM - 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 mail 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 applicant 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 48-02-006 <br /> 11/23104 <br />