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SAN JOAQUIN COUNTY <br /> EN\.ONMENTAL HEALTH DEPART <br /> 600 East Main Street, Stockton, We 95202isgov , L� I <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.s�gov / (d"� <br /> PUBLIC RECORDS RELEASE APPLICATION 111 <br /> APPLICANT: D Ctar I %"' A kt' BUSINESS/AGENCY:_ cY <br /> ADDRESS: 14Vt° N1 I'_�Vvotx CA 4 SSB Z <br /> PHONE(1): Z"aN ' O'D}y PHONE(2): '*'( (oZ-� ' "-SZ FACSIMILE: 7-A9 (a(01 f'(013 <br /> TENTATIVE`APPOINTMENT DATE: 13 V Time: 1%:2Or.� <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE TI2S��i <br /> Electronic Information: ❑ List ❑ Map- Description: <br /> FILE ADDRESSF H E ONLY <br /> Street# Street Name City l,t rO' 1 El Unit 1 <br /> 1: Z�II'I lsltif Lt1v� t SE�otKZ <br /> Unite <br /> �(/ (2010 /I(r,�t� _LpAR S+.t1C�pn ltt� 01 4m �61 Qk� ❑ <br /> ill 3. <br /> VA 4. It,f <br /> 5. <br /> 6 Unit 4 \� <br /> 7. <br /> 8 ❑ Unit 5 <br /> 9. <br /> 10 ❑ Una 6 <br /> Specific Date Range of Information Requested: From Zchat4 to (J IYt N� <br /> / ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYIVEHICLE <br /> O THER CLEANUP SITE(NON-LOP) Cl FOOD FACILITY El WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 173 TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> TATTOWBODY PIERCING ❑ POOUSPA ❑ 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 (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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD48-0 5/1612007 <br />