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DAT <br /> ENE SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> T <br /> )011 ENVIRONMENTAL HEAL H DEPARTMENT <br /> 600 Last Main St, Stockton, CA 95202-3029 <br /> T (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> Ft�vP \Ai�i5Ep�4,ES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C.d °��� r• BUSINESS/AGENCY: _— <br /> ADDRESS: 3' 3y rj rcnr:, Aye �,.-Te.C� CITY/STATE/ZIP: . �ra,•,�, �d � 9SS'�-) <br /> PHONE (1): 2/6 LIVOPHONE (2): FACSIMILE: 14. `/00.06a3 <br /> TENTATIVE"APPOINTMENT DATE: lt ip c, Time: <br /> (Please allow 10 business days from date of application submittal-"tentative only-Must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$1 2 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE P,,l -V- I <br /> Electronic information: [] List Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street it Street Name city 1 <br /> , ,. i, UES 1 I <br /> Unit 2 <br /> I ) N '4 <br /> 5. 3 Ll � 1 � 1 J &40 4,51p unit 3 <br /> .,rJ Unit 4 i <br /> 7. <br /> 8. <br /> ,T ❑Unit s <br /> e <br /> 10. 1 ❑unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES I� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ARATEMENT ❑SOLID WASTE FAC1LI YNEHICLE° <br /> OTHER CLEANUP SITE(NON-LOP) I]FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL ❑DAIRY "- t <br /> HAZARDOUS WASTE GENERATORo` ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑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:OOPM(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)4644138 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 applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> EHU USE ONLY <br /> 3 3� A <br /> EHo 4g-00 <br /> 07f28/10 <br /> 100/L00IJ XVj L1 11 LLOZ/VV OL <br />