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WA <br />• SAN JOAQUIN COUNTY • <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-3029 <br />(209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />1000101 <br />EHD LO NUMBER <br />&I 1*' 11 <br />PUBLIC RECORDS RELEASE APPLICATION <br />I f <br />APPLICANT: R 0 Mt 10 1j BUSINESS/AGENCY: I feo <br />ADDRESS:5S'S / n ClnhOr_ S-�� iso0 CITYISTATE/ZIP:S� <br />PHONE (1): I S ` 9 5_�'- S23 (, PHONE (2); FACSIMILE: N <br />TENTATIVE" APPOINTMENT DATE: qeZ — r I Time: I <br />(Please allow 10 business days from date of appllwtlon submittal .'Tentative only • must be confirmed) <br />❑ CHECK BOX TO EXPEDITER ST- $ CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS W YS <br />SIGNATURE OF APPLICANT �k DATE C% ^ _ <br />Electronic Information: ❑ List ❑ Map — Description: <br />_ FILE ADDRESS <br />EHD USE ONLY <br />❑ Unit <br />Street Is <br />Name <br />City <br />t�Street <br />1 p� <br />Jt <br />r7 <br />Unit2 <br />Llnit3 <br />2. <br />3 <br />— -- <br />q <br />5. <br />.._ <br />__ <br />Unit 4 <br />6. <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />Unit <br />10. <br />i <br />�r <br />Specific Data Range of Information Requested: From — I q L F to � <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES,nn <br />® UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT M SOLID WASTE FACILITYIVEHIC LE <br />OTHER CLEANUP SITE(NON-LOP) F1 FOOD FACILITY <br />❑WASTE TIRE K <br />UNDERGROUND TANK (MONITORINGIREMOVALjx ❑ DOG KENNEL ❑ DAIRY <br />HAZARDOUS WASTE GENERATOR/Y El CHICKEN RANCH WASTEWATER TREATMENT PLANTW' C () <br />TIERED PERMITTED FACILITY ❑MOTEL/HOTEL PUMPER TRUCKIYARD/CHEMICAL TOILETS <br />❑ TATTOO/Boot PIERCING ❑ POOLISPA LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY p OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (Ex"vDING HOLIDAYS) <br />1. List ua 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 approximate) ten (10) <br />days after receipt of application. The files will be held for a maximum of five business days for review. Appointme rits <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 $122 deposit prior to review. <br />51 In 4-,d e <br />Z <br />oTns/te <br />