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I=ron:DHC 2099825757 03/08/20*1 :41 9708 0. 001/001 <br /> DATE RECEIVED <br /> �7 SAN JOAQUIN COUNTY EH©LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.or // d <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; '� ` /� � r - <br /> BU51NfIAG CY: <br /> ADDRESS: Citylstatelzip <br /> PHONE(1) PHONE( �� - G`t FACSIMIL <br /> TENTATIVE'APPOINTMENT DATE: Time; <br /> (Please allow 10 business days from dale viappllcation submittal-•Tentative only-must be confirmed) <br /> t7 CHECK BOX TO EXPED5�$ 05 ITE � ( �®RCHE�:CKONLY)-REQUEST PROCESSED IN 3 BU fSS DAYS <br /> SIGNATURE OF APPLICANT DATE 4 �� <br /> Electronic Information: ❑ List❑ Map—Description: <br /> r6. <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> ©z�- �_aUnit I A <br /> ❑ unit z Unit 3 <br /> Unit4 <br /> 7. <br /> 8. ❑ Unit 5 <br /> 9. <br /> 10. ❑ Unit s <br /> Specific Date Range of Information Requested; From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> *13AZARDOUS <br /> DERGROuND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIUTYIVEHICLE <br /> HER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY D WASTE TIRE <br /> DERGROUND TANK(MONITDRINGIREMOVAL) ❑DDG KENNEL C7 DAfRY <br /> WASTE GENERATOR ❑GHlCKEH RANCH ❑ <br /> 0 TIERED PERMITTED FACILITY WASTEWATER TREATMENT PLANT <br /> ❑MOTEUHOT€L ❑PUMPER TRIICKIYAROICHEM TOILETS <br /> 0 TATTOO/BODY PIERCING ❑POOL/SPA 171 LAND USE APPLICATION SITES <br /> to MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTic PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 ADA-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 484-0138 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 processad the next business day. <br /> 2. The EHD will notify the applicant If any EHD files exlst. 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 appllcatlon 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$105 deposit,prior to review. <br /> gg EHD USE ONLY ( ^� <br /> l HO 48 08 8104108 <br /> PUBLIC RECORDS RELEASE APP FORM <br />