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sKfERECEIVED tnu LUQ rvUMutn <br />a SAN JOAQUIN COUNTY t�, Oft <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-3 <br />T"hone: (209) 468-3420 Fax: (209) 464-0138 Web: ?r1 rgleh <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: ��D�6 -e_ BUSINESS/AGENCY: f=Crvl 9Z(.pZCo <br />ADDRESS: �J2 ZO© CryisTATE�2IP: ccbf° fso" <br />PHONE(1): - ILY — 39 _ PHONE(2):rJ-10—(oYS'Cp2ia0OFACSIMILE:rj10-2qS—Z(aS(p <br />TENTATIVE' APPOINTMENT DATE: r < 2 Zola Time: B Avr\ <br />(Please allow 10 business days from date of appllcaUo submHta 'Te faUVe only - must be confirmed) <br />SIGXCHECK BOX TO EXPEDIT�QUE$115 �F H OR CHECK ONLY) -REQUEST PROCESSED IN 3 BU INESS AYS <br />TURE OF APPLICA/���i� DATE 6 2, <br />Specific Date Range of Information Requested: From <br />Q r -e <br />oto 't 57717 h <br />USE ONLY <br />Unit 1 <br />ALTH DEPARTMENT FILES C <br />❑ HOUSING ABATEMENT 12SOLID WASTE FACIHTYNEHICLE �\ <br />OTHER CLEANUP SITE (NON -LOP) <br />UNDERGROUND TANK (MONITORING/REMOVAL) of <br />❑ FOOD FACILITY <br />❑ DOG KENNEL <br />❑ WASTE TIRE <br />❑ DAIRY <br />HAZARDOUS WASTE GENERATOR d' <br />TIERED PERMITTED FACILITY (� <br />❑ CHICKEN RANCH <br />❑MOTEL/HOTEL <br />ASTEWATER TREATMENT PLANT �(, <br />MPER TRUCKIYARDICHEMICAL TOILETS <br />TATTOOIBODY PIERCING <br />❑ POOLISPA <br />❑ LAND USE APPLICATION SITES <br />1 MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />Specific Date Range of Information Requested: From <br />Q r -e <br />oto 't 57717 h <br />ma�yY,�'� ENVIRONMENTAL <br />�uNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />ALTH DEPARTMENT FILES C <br />❑ HOUSING ABATEMENT 12SOLID WASTE FACIHTYNEHICLE �\ <br />OTHER CLEANUP SITE (NON -LOP) <br />UNDERGROUND TANK (MONITORING/REMOVAL) of <br />❑ FOOD FACILITY <br />❑ DOG KENNEL <br />❑ WASTE TIRE <br />❑ DAIRY <br />HAZARDOUS WASTE GENERATOR d' <br />TIERED PERMITTED FACILITY (� <br />❑ CHICKEN RANCH <br />❑MOTEL/HOTEL <br />ASTEWATER TREATMENT PLANT �(, <br />MPER TRUCKIYARDICHEMICAL TOILETS <br />TATTOOIBODY PIERCING <br />❑ POOLISPA <br />❑ LAND USE APPLICATION SITES <br />1 MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC 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 mall 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 <br />Future file reviews by the same applicant may require a $115 deposit prior to review. <br />S. If you need further assistance, please contact Diane Martinez, at (209) 468-3425. <br />3- <br />