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DINE RECEIVEb EHD LOG NUM9ER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> I F I fIP 800 East Main Street, Stockton, 38 95202-30295?Telephone; <br /> (209) 468-3420 Fax; (209) 464-0138 Webvawwsj <br /> F <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I ,toad rllp n Q A BUSINESSIAGENCY: Z(.r. <br /> ADDRESS; �2sYI CI 11G;'fYI'a X a)a&I -_. Citylgtato2lp 1�C&I <br /> PHONE(1): PHONE(2): FACSIMILE: —(pR�NZZ� <br /> TENTATIVE"APPOINTMENT DATE: Tim:allow 10 business days from data of application submittal-•TBntail v only.must be COnflrmod) <br /> In CHECK BOX TO EXPEDITE REEQUgxST-$ius FE6,(CAgH OR CHECK ONLY)-REQUEST PROCESSED IN a BUSINESS DAYS <br /> SIGNATURE OF APPLICANT el�U Q t > DATE <br /> Electronic Information: ❑ Llst Ej Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Nems City <br /> Unit I <br /> r <br /> a. .Q 34 =-.H.L�k�y- tk�r^_�. — ❑ u <br /> 4. ant, <br /> 6. 44 <br /> 7. — <br /> g, ❑ units <br /> 9. <br /> 1U ❑ units <br /> Specific Date Range of Information Requested:From to <br /> f ENVIRONMENTAL HEALTH DEPARTMENT FILES �-�� �. <br /> lu O. RRGROUND TANK(UST)CLEANUP 31rE tLOP) ❑HOUSING ABATEMENT 0 SOLID WASTE FACILT'NEMCLE <br /> �THER CLEANUP SITE(NON-LOP) C7 FOOD FACILITY E3WAsTE TIRE <br /> C DERGROUND TANK(MONRORINOIREMOVAL)`Y�, 13 DOG KeIJNEL E3 DAIRY <br /> 5kAZARDOU5 WASTE GENERATOR D CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> Jd TIERED PERMITTED FACILITY p( C3NrrELIHonL CI PUMPER TkUCKIYAROICHEN TOILETS <br /> C]TAT maIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> El MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIPY) <br /> weL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR Rmow . MONDAY-FRMAY 6:00 AM-6:OOPM - EXCLUDING HOLIDAY$. <br /> 1. List up to ten addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0136 or meq 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 tan(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 filo not returned In the some condltlon as released will be reorganized by EHD staff at the expense or the applicant <br /> Future filo reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> 5 <br /> ND 4 -004/08 <br /> PU6LIC RECORDS RELEASE APP FORM <br />