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DATE RECEIVED EHD LOG NUMBER <br /> ' ff���'( j'_;j SAN JOAQUIN COUNTY <br /> n'L' ` '`^!I `J�L=�L " ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> �IlSf'! '008 Telephone: (209)468-3420 Fax: (209)454-0138 Web: www.sjgov.org/ u5i <br /> 3 <br /> P c PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 BUSINESS/AGENCY: <br /> 39,-1)"1 <br /> ADDRESS: 3I 1'1cn ��•�: Ave ���:�a L Scv ra�er.lo LA LLL <br /> PHONE(1): PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time. <br /> (Please allow ten business days from date of application submittal-"Tentative only-must be confirmed) <br /> 171 CHECK BOX TO EXPEDITE REQU T-$98 00 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN//THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description; <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name City ❑Unit 1 <br /> la.5 <br /> 2' �y�6 c W �1 All, a /110yC`I �n0co _., ❑Unit <br /> rip <br /> v 3 hJJ ' GnZc�v� �.� n C N9UU �' <br /> 4. �ou N odL�2 1 n 0 COI nit <br /> vt <br /> 0Q _ $ J �o�. NOco/Sri Ito <br /> 0, <br /> 8• a Unit s <br /> 9. <br /> 10- ❑Unit 6 <br /> Specific Date Range of Information Requested:From MD to 1 r n 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ) <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOU&NCI ABATEMENT ©SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NOWLOP) ❑FOOD FACILITY 17 WASTE TIRE <br /> tXUNDEROROUNO TANK(MOHITORINO/REMOVAL) X ❑DOG KENNEL ❑DAIRY <br /> M HAZARDOUS WASTE GENERATORX O CHICKEN RANCH 17 WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY O MOTEL/HOTEL ❑PUMPER TRUCK/YARD(CHEM TOILETS <br /> C3 TATToo/BODY PIERCING ❑POOUSPA 13 LAND USE APPLICATION SITES <br /> Cl MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY$.00 AM-5:0OPM - 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 above address. Address ranges)will <br /> not be accepted-for additional assistance with file addresses,contact the END. Applications received after 3:00 pm will <br /> 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 <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 /> a. A file that Is actively being worked on by the EHD staff may not be Immediately available for review. A new application <br /> may be 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$98.00 deposit prior to review. <br /> 1EHD SE ONLY <br /> a - i <br /> END 41"S 10M? PU-uL4-AE0oRvs RELEASE APP FORM <br /> L00/LOOf�] XU9 9z: VL 80OZ/GO/90 <br />