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eJ2/UZJ/2bbb 15:52 9166439685 TETRA TECH MCCLFI I-AN PAGE 01/01 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUJN C®UN 1Y <br /> `L 1 I +`.\i;''�;i ETSWrRQNMENTA L HFALTH DEPARTMENTI n;,L, I I 1 ';.� t LUJ 304 East Weber Avenue, 3'd Floor, Stockton, CA,95202-2708 <br /> *7� 20Ga Telephone:'(209)448-3420 Fax:(209)464-0138 Web:www.sjgov.or&/ehd <br /> PUBLIC RECORDS RELEASE APP'LICAUON <br /> SUSINESSIAGENCY: 7s_7-e,4 75-7,S/, Ak. <br /> ADDRESS:_ �%!yU -?9-TYt' �✓r4y �u�T /L3l ` <br /> PHONE(1): .R!r!_/ —PHONE(2): - - FACSIMILE: . <br /> TENTATIVE*APPOINTMENT DATE. Z-22-C1.6 Time: <br /> (Please allow 10 business days from date of application Submittal-*Terrt&6ve Only-must be conflrmed) _ <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$9 C(CAS CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SiGNATUl2r-- OF APPLICANT DATE <br /> UNIT=TmsimON Q Unit 1 ❑ Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit& O Other(eleatl'onianis'Wmaps) <br /> _ FILE ADDRESS <br /> street Name City EHD USEJ <br /> _Strc+et!� T <br /> - _ <br /> 3. <br /> 4. <br /> 5. <br /> 7. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNOERGROuNa TANK(UST)CLEANUP SITE(LOP) 0 Housma ABATEMENT SOLlo WASTE FAciLrrYNEHiCuc <br /> OTHER CLEANup SrrE(Nom-LOP) ❑F000 FAciLnY ❑WAsTE TIRE <br /> UNDERGROt;N4 TANK(MONITORINC-.IREMOVAL) ❑DOG KENNEL 4 DAIRY <br /> l HAZARDOUS VVAmm GENERATOR ❑CHICKEN RANCH -e WASTEWATER TREATMENT PLANT <br /> TIERED PERAI'r'TSD FACILITY ❑MOTE11HOTEL ❑ PUI3rPER TRUCX1YARDICHEM TOILETS <br /> ❑TATToo1Bom,PIERCING ❑POOLISPA ❑iAINo USE AppucAnCN SIYEs <br /> ❑MEDICAL WATE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> W:31.L AND SEPTiC P'ERMrr RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRPJAY 8:00 Am-,5.00w - EXCLUDING IiouDAiYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fay to(2091 A164-0 38 or 11 to the address <br /> indicated abov_e._ Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EH. Applications received after 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 <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of flee business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file the;is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application 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 <br /> applicant.Future file-reviews by the same applicant may require a$93.00 deposit prior to review. <br /> giotaae <br /> iM�RAS <br />