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uAItKLUEIVEO ! EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> S{ ENVIRONMENTAL HEALTH DEPARTMENT <br /> vel 304 East Weber Avenue, 3`d Floor, Stockton CA 95202-2708 <br /> '�QQ� Telephone:(209)468-3420 Fax: (209)464-0138 Web:www,sigov.org/chd <br /> HEPL�� PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESSIAGENCY: UR5 {', 6�'G� <br /> TRESS: Tr Z ( YVt <br /> PHONE;(1). 3 <br /> T Zr PHONE(2); _)0) 3,32 1 FACSIMILE:: I I f s-) <br /> TENTATIVE"APPOINTMENT DATE: 1pla, l I. 2a� G _Time: 10-,d'c <br /> (Please allow 10 business days from date of applica is-fin submittal."Tentative only'-must ba confirmed) <br /> E2 CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Il 6/Z��nl <br /> Electronic Information: ❑ List[]Map-Description: <br /> FILE ADDRESS I EHD USE ONLY <br /> Street!f Street Name Clty ❑ Unit 1 <br /> , �+ Rel. 2- 1k,�z , Imo. <br /> 2. 5 1 <br /> ❑ Unit <br /> 3. <br /> 4. unit 3 <br /> �V) <br /> W _5 ` 5. <br /> 6. FVrm a,rc�'_ F I 11b c <br /> 7. <br /> $ ❑ unit 5 <br /> O <br /> nu-It <br /> Specific Date Range of Information Requested:From l Ir?�1[� to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACELnYNEH1CLE <br /> 13 OTHER CLEANUP SITE(NON-LOP) LI FOOD FACIuTY WASTE TIRE <br /> 17 UNDERGROUND TANK(MONtTORINGIREMOVAL) ❑DOC KENNEL D DAIRY <br /> itHAZAswous WASTE GENERATOR D CHICKEN RANCH D WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY MOTELIHOTEL D PUMPER TRUCKIYARDICHEM TOILETS <br /> ©TATTOOIBODY PIERCING Q POOL/SPA 0 LAND USE APPLICATION SITES <br /> D MEDICAL WASTE FACILITY D OTHER(PLEASE SPECIF <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM EXCLUDING HOLEDAYS. <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 jo(2091464-008 or mail to the address indl °ted 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 appolntmeht 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 EHO staff may not be Immediately available for review. A newapplication 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 fife reviews by the same applicant may require a$95.00 deposli prior to review. <br /> EHD USE ONLY <br /> EHD,6-06 9h3r4W <br /> L/L t9L6LB8S14 uol�eiotl�o0 S2in rVd SI:ZI 9DGZ1/LL/ll <br />