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HPr 01 11 04: 48p P. 1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT I \*n® <br /> 600 East Main St. Stockton, CA 95202-3029 ,/'► VJ�`' <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd04 VVV <br /> PUBLIC (RECORDS RELEASE APPLICATION <br /> EA'Idpp � 1 ��.�_ BUSINESS/AGENCY_SLIS4\ <br /> ADD ESS: -✓L L'-z�, t�1e.c1S 2j�t-t\tF. .l L�'-P A CITY/STATE2IP: I��Q q SC,_UI IL(� . C-I+ °14 SfiE\ <br /> PHONE(1): O 5 - )34-1D4�p _ PHONE(2):gras,q(19-02.S0 FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE R����FFFFeeggAqqq1UEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTS j-({�� DATE _�q—tel <br /> Electronic Information: ❑List❑Mlap—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street R_ _ Street Name City nil 1 <br /> U Unit 2 <br /> 3. <br /> 4. D-fJnit 3 <br /> 5. <br /> 6. --- -- .- — B6unit4 <br /> 7. <br /> 8. ❑unit s <br /> 9. <br /> 10. Untt 6 <br /> Specific Date Range of Infnrmadon Requested' From 1 JJ j 1 Q L-\ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES -;7�1e% /• <br /> UNDERGROUND TANK(us r)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILRYNEHICLE LO .i 1J <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE `{ f0 <br /> UNDERGROUND TANK(MONRORINGIREMOVAL)CY\ [I DOG KENNEL [I DAIRY � 1/11 l z _11 <br /> ®HAZARDOUS WASTE GENERATOf� F1 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT tM <br /> ❑TIERED PERMITTED FACILr'Y ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITI ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY S:OO AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addre<..ses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least ons file type MUST bo selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be a1.cepted-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 Miles 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 returner in the same condition as released will be morganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> EHO USE ONLY <br /> • / %n <br /> EHD 41-06 Grime <br />