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-/11 t KtctlVtU EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY �..- <br /> ENVIONMENTAL HEALTII DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 �� <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.orglehd� <br /> PUBLIC RECORDS RELEASE APPLICATION IIJ <br /> APPLICANT: r - m BUSINESSIAG//ENCY: [� <br /> ADDRESS: Y �y7Y Cr+r«s tf4C STATE e ` <br /> PHONE(1):j�t (t 7 —0&6 6 P ONE(2): FACSIMILE:L-7[, 8 " ?C)2z <br /> TENTATIVE`APPOINTMENT DATE: Time: lT— <br /> (Please allow 10 business days from date of application submittal.*Tentative only-must be confirmed) <br /> O CHECK BOX TO EXPEDITE REQUEST-)9,3.00 FEE(CASH OR CHIf�-N'L QUEST PROCESSED IN BVSINESS AYS_ <br /> SIGNATURE OF APPLICANT 4- ��i� ( DATE <br /> ornation <br /> nEfe lc 13 List 13 Map.Description <br /> I <br /> FILE ADDRESS EHD USE ONLY <br /> street Street Name city <br /> 1. <br /> 2. 1-1 Unit 1 <br /> 3. ❑ Unit 2 <br /> 4. v <br /> 5. Unit3 <br /> 6. <br /> 7. / Unit 4 <br /> 8. <br /> 9. ❑ Unit 5 <br /> 10. <br /> — IV'Unit 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERCROUN11 TANK(UST)CLEANUP$ITE(LOP) ❑HOUSING ABATEMENT OLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SrTE(NON-LOP) ❑FOOD FAC%.ITY ❑WASTE TRE <br /> NDERGROUND TANK(MONITORINGlREMOVAL) ❑DOG KENNEL - ❑ DAIRY <br /> DOO WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY N.F.F ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑ 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail 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 fora 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 /> n d <br /> END 4346 <br /> 1min"s <br />