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SAN J OAQUIN COUNTY <br /> ENONMENTAL HEALTH DEPART& <br /> 600 East Main Street, Stockton, CA 95202 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: xNwNv.sjg V =1 <br /> hh <br /> PUBLIC RECCORDS RELEASE APPLICATION <br /> APPLICANT: U C�hJ %"' Ak-t`^ BUSINESSIAGENCY: . <br /> a <br /> ADDRESS: y�C4 T1. ( Q'kt ' 5Aa - Utl, rh C . I uv�-'AX 'C14 q Sag Z <br /> PHONE(1): Z-"N Cm - F1PHONE(2): � ��� - Z'f-SZ FACSIMILE: Z'ol <br /> TENTATIVE*APPOINTMENT DATE: i3 r3 Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> 171 CHECK BOX TO EXPEDITE REQUEST,-x$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE AZT'k� - <br /> Electronic Information: ❑ List ❑ Mala— Description: <br /> FILE ADDRESS_ E E ONLY <br /> J Street# Street Name City L ❑ Unit 1 <br /> Llo:5 ❑ Unit 2 <br /> -3. — <br /> 4. Unit 3 <br /> 5. <br /> 6. Unit 4 <br /> 7. <br /> 8. - ElUnit 5 <br /> 9. <br /> - ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to ('J 't V'Q A�- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> xUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUPS ITE(NON-LOP) 11 FOOD FACILITY 71 WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLISPA d 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-5:00PM - 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 approximately ten (40) <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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48.06 SY1612007 --- <br />