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DIVED I EHD LOG NUMBER <br />i'`_ SAN JOAQUIN COUNTY <br />11 J L- u <br />ENVIRONMENTAL HEALTH DEPARTaN <br />600 East Main St. Stockton, CA 9520 09 <br />Tlephone: (209) 468-3420 Fax: (209) 464-0138 We sjgov.orglehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />ADDRESS: <br />A . -T( <br />PHONE (1): 610—T,09-9611 - PHONE (2 <br />TENTATIVE" APPOINTMENT DATE: f--riJ <br />(Please allow 10 business days from date of <br />BUSINESSIAGENCY: <br />S} C 2COCITYISTATEIZIP: Co 5f k M 165 GA , C 0-Lo'Z <br />S10-C�S�-(oZ(p FACSIMILE: SiU�zq 5' 2�PcJ% <br />2 2 d U Time: lam <br />3plication submittal - Tentatfve only - must be confirmed) <br />HECK BOX TO EXPEDITE REQ T - $115 SH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUST ESS Di1,YS <br />SIGNATURE OF APPLICA� DATE X11 2S I <br />Electronic Information: ListMap - <br />scription: <br />rb✓�" u n �r �� <br />Street # <br />FILE ADDRESS <br />Street Name <br />e� EHD USE ONLY <br />City ❑ Unit 1 <br />CDi h S'� <br />L v`S S��, <br />0-tNo co <br />co<�2 <br />si Unit 2 <br />2. <br />�- <br />3. <br />= C", <br />V_ <br />GLYlS�l?. <br />Unit a <br />''�G%fUnit 4 <br />4. <br />5. <br />3 <br />6. <br />ZZ�j <br />�GL6 n <br />r- , bio n <br />8. <br />4 0 icor <br />A 0 Unit <br />8. <br />) 02-2, <br />T' <br />V Unit 6 <br />10. <br />Speck Date Range of Information Requested: From �_(� 1r (i C' to / <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br />��IAZARDOUS <br />OTHER CLEANUP SITE (NON -LOP) ElFOOD FACILITY WASTE TIRENDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ElDAIRY WASTE GENERATOR ❑ CHICKEN RANCH WASTEWATER TREATMENT PLANT f <br />IERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />Q{t%' " ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ OTHER (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 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 applicant. <br />Future file reviews by the same applicant may require a $115 deposit prior to review. <br />5. If you need further assistance, please contact Diane Martinez, at (209) 468-3425. <br />ENn USE ONLY <br />WUL); 2?�2no r-UU, LOOM i� 1 <br />