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QATErs~ly� I <br /> F�=a'.�,. EHD LOG NUMBER <br /> �]� ''�lj SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> PUG 1 � 2���$ 600 East Main St. Stockton, CA 95202-2708 <br /> Telephone: {209)468-3420 Fax: {209)464-0138 Web: www.sjgov.org/ d <br /> I1110i iiriLl�z i�_:.i-1_: E 515 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> f' APPLICANT: J0/1I LWe5/JE BUSINESSIAGENCY: e E���r 6, "'_�al i/AL <br /> I ADDRESS:_ t 1 I�;yx 7, _ CITY/STATEIZIPt�GC�Gr� G� ` <br /> PHONE{1): PHONE(2): FACSIMILE: rRy� <br /> G - j- - <br /> TENTATIVE*APPOINTMENT DATE: <br /> (Please allow 10 business d s from date of applications mitta 'Te a i ly rESSED <br /> st be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQ S -$705.00 ASH OR CHE L E EST P fN 3 BUSINESS DAYS <br /> {{ SIGNATURE OF APPLICANT DATE - <br /> i' <br /> s� <br /> 14 <br /> Electronic Information: <br /> � ❑ List E] Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. � 7 VE 0-> off':moi✓ ' <br /> 2. <br /> 3. <br /> 4. �,f. © Unit 3.:. <br /> 5. <br /> i 6. Unit 4 <br /> 7. <br /> f g. ❑ Unit 5 <br /> 9. <br /> j 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEHICLE <br /> 13 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> 0 UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL IRY <br /> O HAZARDOUS WASTE GENERATOR © CHICKEN RANCH trIWASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL DUMPER TRUCKIYARD/CHEM TOILETS <br /> 0 TATTOOIBODY PIERCING 1.1POOL/SPA LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 5:00 AM-5:00Pn1 - EXCLUDING HOLIDAYS. <br /> 1. List up to ken 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(2091464-0138 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 /> i 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately tenl(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> i 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 /> k 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$105.00 deposit prior to review. <br /> EHD USE ONLY <br /> u. <br /> f ***If you need further assistance please contact Diane Martinez @ {209}468-3425 directly. Thank You*** <br /> r <br /> I <br /> i <br /> EHD 48-06 <br />� 8104/208 <br />