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��� EMU LUG NUMtltK <br />- I I , iij ..,i SAN .JOAQUIN COUNTY ti - <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-30 <br />hone: (209) 468 <br />Te'e�l3420 Fax: (209) 464-0138 Web j rg/eh <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: 1.6 LA Ty--e-,lo BUSINESS/AGENCY: 1= C 9 Z -(a Z (o <br />r <br />ADDRESS: 35 L'ZV We , bk e OU CITYISTATE2IP: <br />PHONE(7): P1HONE(2): 510-%?S-c`p2(vp.FACSIMILE: 510 -295- 26S(p <br />TENTATIVE" APPOINTMENT DATE: j (; d A�A , 4 A t�, 2. , -Lo 10 Time: S A yr <br />(Please allow 10 business days from date of applicati subm 'Te ve only -must be confirmed) <br />j��( CHECK BOX TO EXPEDI=QU�� $115 F H OR CHECK ONLY) -REQUEST PROCESSED IN 3 BU INESS DAYS <br />SIGNATURE OF APPLICA��� DATE Ca Z <br />Specific Date Range of Information Requested: From <br />eQ rI I -C <br />_FILE ADDRESS�_�' !'�.1EHDUSEO LV <br />a, unit 1 <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />UNDERGROUND TANK (MONITORINGIREMOVAL) 01- <br />A� <br />HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />IERED PERMITTED FACILITY (JL <br />❑ MOTELIHOTEL <br />] TATTOOBODY PIERCING <br />❑ POOLISPA <br />] MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />! EVIR <br />�' WN <br />Specific Date Range of Information Requested: From <br />eQ rI I -C <br />��y(���� ENVIRONMENTAL ALTH DEPART <br />5UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />UNDERGROUND TANK (MONITORINGIREMOVAL) 01- <br />❑DOG KENNEL <br />HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />IERED PERMITTED FACILITY (JL <br />❑ MOTELIHOTEL <br />] TATTOOBODY PIERCING <br />❑ POOLISPA <br />] MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />SOLID WASTE FACILTTYNEHICLE <br />❑ WASTE TIRE <br />❑ DAIRY <br />ASTEWATER TREATMENT PLANT <br />MPER TRucKIYARDICHEMICAL <br />❑ LAND USE APPLICATION SITES <br />7 <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 />9 <br />caruaaare��4•tvn a�iai4Tlr•�.e�f,LT1 r7A",'uWi7C%� <br />Ai�ltr,►fr-r�ncr..-��� � SIR r. <br />