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.......... <br /> DATE RECEIVED SAN JOAQUIN COUNTY FHD LOG NUMBER' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> -3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> jfijephone: (209)468 <br /> JUL 0 <br /> RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> BUSINESSIAGENCY: _jJ;_k <br /> ADDRESS: t KUL CITYISTATEIZIP: <br /> PHONE(14 j?45 g-0!7 q2, PHONE(2): FACSIMILE: <br /> TCNTATWE*AP_P0INTMENT DATE: Time: <br /> . (Please allow 10 business ys from date of application submittal-*Tentative only-must be confirmed) <br /> E] CHECK BOX TO EXPEDITE REQUE -$1 FE CASH ONLY)-REQUEST PROCESSED IN 3 BUSINESS�AYS <br /> b DATE rl <br /> SIGNATURE OF APPLICANT I <br /> FE - <br /> Electronic information: El List[I Map—Description:. <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city Unit 1 <br /> _' <br /> a <br /> c <br /> Unit 2(W <br /> 4- <br /> 4. cQq -A- <br /> 170 �0 Z Unit 3 L%. <br /> fi- 99 G.6. unit4 i�, <br /> 6W T, <br /> Q.--3 go pf. Vr� u� <br /> 8- <br /> t( -D d_A4�V Z:4� <br /> 91_�)-5 Li ea <br /> 9- - L 350 - It <br /> pok ;rs)_ubf;r <br /> 1-0. a-m 0-Wir- V.T- Ii v. F I Unit <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES q <br /> OUNDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY SOLID WASTE FACI�IT,Y[VEHICV <br /> �XOTHER CLEANUP SITE(NON-LOP) RHOUSING ABATEMENTWASTE TIRE fIV5 <br /> RNDERGROUND TANK(MONITORINGIREMOVALtk Q FOOD FACILITY DAIRY 'ps <br /> ABOVEGROUND TANK 0<— F❑]CHIC KEN RANCHI I)OG KENNEL ASTEWATER TREATMENT PLANT <br /> [HAZARDOUS WASTE[HAZARDOUS MATERIALS-< ❑MOTELIHOTEL PUMPER TRUCK[YARDICHEm:cAL TOILETS <br /> [TIERED PERMITTED FACILITY D� DOOLISPA U(AND USE APPLICATION SITES <br /> u <br /> VTATTOOIBODY PIERCING 9COMPLAINT/RESPONSE RECORDS ILOTHER(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 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 approkimately ten(10) <br /> days after receipt of application. The files will be hold 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$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY— <br /> /AA <br /> A4!:4 aen <br /> Kn <br /> JA-A- <br /> (fA4 <br /> M <br /> Reemd"re4,ided-bV-St'aYzPPR-Corrtplete- <br /> EHD 4M6 to <br /> 014112 <br />