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DATE RECEIVED EHD LOG NUMBER �.. SAN JOAQUIN COUNTY NVAEGEENVIRONMENTAL HEALTH DEPARTMENT 2012 600 East Main St. Stockton, CA 95202-3029 rAj l Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd 0 aAVPE.RMISWP' gCW PUBLIC RECORDS RELEASE APPLICATION APPLICANT:- L DT1 '1St SBUSINESS/AGENCY: 600" J � ADDRESS: 9 �YDd j� pil 5Vt �6 CITY/STATE/ZIP: Sb.MF4 PHONE (1): Z61 PHONE (2): U T L27_7 JOY FACSIMILE: 167 44g"- !rfb L TENTATIVE*APPOINTMENT DATE: Time: (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) ❑ CHECK BOX TO EXPEDITE RE $125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE `t?A. /Z Electronic Information: ❑ List❑ Map—Description: FILE ADDRESS EHD USE ONLY Street# Street Name City E] Unit 1 1 -Y'§-o..qU C h rw XJ60JA-V 64.1 2. Unit 2 3. } 7� p 4. yi 1 .iCJ Unit 3 5. ***PLEASE RESPOND AS SOON AS POSSIBLE. 6, I NEED TO NOTIFY APPLICANT DURING _211,5it T WEEK OF 5/14/12 IF EHD HAS FILES FjDRq 8. LISTED ADDRESSES OR NOT ❑Unit 5 9. 10. �� 1� ❑unit 6 Specific Date Range of Information Requested: From to ENVIRONMENTAL HEALTH DEPARTMENT FILES rrrQrrr=��=��rr1---U''''''NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY BHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT [TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address ranges will not be accepted-for additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$125 deposit prior to review. EHD d9-08 eHHt