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Apr 01 11 04: 48p P • 1 DATE RECEIVED EHD LOG NUMBER SAN .JOAQUIN COUNTY ID ENVIRONMENTAL HEALTH DEPARTMENT `*n 600 East Main SL o Stockton, CA 95202-3029 (/3` Telephone: (209)468-3420 Fax: (209)464-0138 Web:www,sjgov.org/ehd R 64t U}1 PUBLIC RECORDS RELEASE APPLICATION EWpF t 1 �� BUSINESS/AGENCY: JLI��\ Eamli �:flG ADDRESS: (-leZc�, \��'-l1S 'tjXl IP.S,.-L \a CITY/STATE/ZIP: `c+_'i�f[1,A -b L�14 S8E� PHONE(1): O < --)3ti-rn�loe _ PHONE(2): 4a5-q?'l0j-9_,2_S0 FACSIMILE: qaS- 7SIA lgD4C1) TENTATIVE'APPOINTMENT DATE: Time: (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) ❑CHECK BOX TO EXPEDITE RFAUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT,.t L,4l, (L. ) DATE Electronic information: ❑List❑Mlap—Description: FILE ADDRESS EHD USE ONLY Street A Street Name City nit t 2 I it 3 6945W ❑Unit e 3. �y 4. -._—-------------------- Nt3 5. 6. 2nit4 7. 8. ❑Unit S 9. _ 110. 1 1 ❑units Specific Date Range of Information Requested; From t ctq t\ to ,pfe5 t + �IQ C �1 ENVIRONMENTAL HEALTH DEPARTMENT FILES l UNDERGROUND TANK(Us r)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIUTYNEHICLE OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE `\ , UNDERGROUND TANK(MONRORINGIREMOVAL)�( E]DOG KENNEL ❑DAIRY HAZARDOUS WASTE GENERATOR _ ` ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT TIERED PERMITTED FACILr'Y ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILnI ❑OTHER(PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY B:OG AM-S:OOPM(EXCLUDING HOLIDAYS) 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 box(es). At least on.file type MUST bu selected. Fax to 1209)464.0138 or mail to the address Indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact the END. Applications received after 3:06 pm will be processed the next burliness day. 2. The EHD will notify The applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) days after receipt of application. The l➢les will be held fora maximum of five business days for review. Appointments should be scheduled accordingly, 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be submitted when the file is available. 4. Any file not returner in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same appllca nt may require a$122 deposit prior to review. RHO USE ONLY T— o T7-. END fi — ornsno