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° j SAN JOAQUIN COUNTY EHD LOG NUMBER <br />21Q1 ENVIRONMENTAL HEALTH DEPARTMENT <br />a� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />T i�1$ne:--(209)-468-3420-IFax: (209)-464-0138-Web:-www.sjgov.orgfeh - -- <br />POW PUBLIC RECORDS RELEASE APPLICATION <br />J <br />APPLICANT: <br />ADDRESS: ._.. <br />PHONE `z `ice <br />TENTATIVE*APP 1NTMENT DA <br />(Please allovQo bulsiness days <br />BUSINESS/AGENCY: <br />CITYISTATE/ZIP: <br />PHONE (2): FACSIMILE: <br />Time: <br />i date of application submittal -*Tentative only - must be confirmed) <br />❑.. CHECK BOX TO EXPED 25 FEE CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />GNFITURE OF APPLICANT`" DA�/�G' .-— - <br />Electronic Information: ❑ List ❑ Map— Description: <br />FILE ADDRESS <br />EHD USE ONLY f <br />1] Unit 9 . <br />Street # <br />Street Name <br />City <br />r{P VA i t <br />i] Unit 2 <br />2. <br />3. <br />U Unit 3 <br />4. <br />UnM4 <br />6.+❑ <br />7. <br />d Unit 5 <br />$, <br />9. <br />d11, Unit 6 <br />I <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ED1CAI WASTE FACILITY SOLID WASTE I ACILITYIIIEHICLE <br />OTHER CLEA14UPSITE (Ir'ON-LDP) I HOU SING ABATEMENT WASTE TIRE qjko5 <br />In UNDERGROUND TANK (MONITORINGIREMOVAL) FOOD FACILITY DAIRY 10-9—"'3 <br />[] ABOVEGROUND TANK CHICKEN RANCHI DOG KENNEL WASTEWATER TREATMENT PLANT <br />*kHAZARDOUSWASTEMAZARDOUSMATERIALS (/C fr]MOTELIHOTEL PUMPER TRUCKIYARDICHEMICALTOILETS <br />TIERED PERMITTED FACILITYp� POOLISPA LAND USE APPLICATION SITES <br />TATTOoIBODY PIERCING.COMPLAINTIRESPONSE RECORDSOTHER (PLEASE SPECIFY) <br />�QQQ3 <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:0 M-5:0[YPM (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) 46470138 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 (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 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 $125 deposit prior to review. ***BOXED AREA - EHD USE ONLY*** <br />MIS 0'q ITS <br />•l _� <br />■ Records provided by Staff -PPR Complete. staff Name: <br />EHD 48-06 <br />