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• <br />i (e'__7 <br />Ir �� ED St PHD LOG NUMBERPIT SAN JOAQUXN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3'd Floor, Stockton, CA 95202-2708 <br />EiSVIRUi�1;v"Ei�l1 ;-�EALTi� <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov_org/ehd <br />2. 50p'( <br />Pl:P'm1 1/S� V1GES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: --MAP-( G Liu o /z-=rBUSINESSIAGENCY: �� �� 7� C0WULrir-U <br />ADDRESS: �f) / --7-(a 1 Wevs .5 �-ry'x <br />PHONE (1): _�0 —iY(a3 � (P.SC PH NE (2): " —�T1 -}� <br />"� � �O F CSIMILE:S70 — t�� —4 <br />TENTATIVE" APPOINTMENT DATE: FJ6 - TAM I,r Time: 3 O <br />(Please allow 10 business days from data of application submittal -*Tentative only -must be confirmed) <br />171 CHECK BOX TO EXPEDITE REQU T - $93.00 FEE (CASH nR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />■ Unit 1 0 Unit 2 ■ Unit 3 13 Unit 4 ■ Unit 5 11 Unit 6 ■ Other <br />swum <br />MA <br />a .ti'I� <br />�e•��'rl <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />fir UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HousING ABATEMENT ❑ SOLID WASTE FACILrrYNEHICLE <br />1XOTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY G WASTE TIRE <br />PUNDERGROUND TANK (MONITORINWREMOvAL) ❑ DOG KENNEL ❑ DAIRY <br />.HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL 13 PUMPER TRUCKIYARDICHEM TOILETS <br />❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITE$ <br />171 MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REy1Ew - 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 <br />appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mall to the address <br />Indicated above. Address ranges will not be accepted —for additional assistance with file addresses, contact <br />the EHD. Applications received after 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 <br />approximately ten (10) days after receipt of application. The files will be held for a maximum of five business <br />days for review. Appointments 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 <br />application may be 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 <br />applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />EN❑ 4At2406 <br />1/1495 <br />2000 GNYINVO XIHLLVNORD TfTt C99 OT9 XH,3 90:tT ,LA'S 90/6T/TT <br />