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DAT D • EHD LOG NUMBER <br /> JF IV SAN JOAQUIN COUNTY <br /> 3 2014 ENVIRONMENTAL HEALTH DEPARTMENT g� <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> NMEt4jTA1�t�F : (209)468-3420 Fax: (209) 464-0138 Web: www,sjgov.org/ehd <br /> ERM�IsERAcEsPUBLIC RECORDS RELEASE APPLICATION >: <br /> APPL-46ANT: /J BUSRt ESS/AGENCY JW. S 7 <br /> ADDRESS: r�[ CITY/STATE/ZIP: fyK U, <br /> PHONE(1): 3 PHONE(2): FACSIMILE: <br /> T NTAT/VE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of appl'cad0n submittal-`Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CP OR CHE LY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SI NATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name . City nit 1 <br /> o�ov� L /kv� M UST vz ,clX <br /> 2. M GA c0 <br /> 3• ❑ Unit 7�t/ <br /> 4. <br /> DUnit 3 <br /> 5. <br /> 6. � A <br /> �Unit4 <br /> 7. U�W <br /> 8. <br /> ❑ Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information P.equested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> .f UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITY'NHICLE <br /> _B-OTHER CLEANUP SITE(NON-LOP) EI HOUSING ABATEMENT ❑WASTETIRE 7J- ,e I,n Efo/ > <br /> .0 UNDERGROUND TANK(MONITORINGIREMOVAI&>(, ❑FOOD FACILITY ❑DAIRY t _��t/�> <br /> k]ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL )d/3 <br /> D HAZARDOUS WASTEIHAD ARDOUS MATERIAL ❑WASTERTRUCKf EA D/CH PLAN <br /> 6QC El ❑PUMPERTRUCKIYAROICHEMICALTOILETS <br /> rTIERED PERMITTED FACILITY ❑POOLISPA .❑LAND USE APPLICATION SITES <br /> y I TATTOO/BODY PIERCING aCOMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY S:00 AM-S: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)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 app ro dmately 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$125 deposit prior to review, *•*BOXED AREA-EHD USE ONLY*'• <br /> lu' lL t �lllz <br /> r <br /> ❑ Records provided by Sta PPR COMPTete. Staff Name: <br /> EHD 46A6 <br /> 914112 <br />