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`:FINED 1"U LvO rvuMCtK <br /> al SAN JOAQUIN COUNTY <br /> EN-VI70NMIENTAL HEALTH DEPARTXI NT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 �� <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION 1 n y,p <br /> ,PPLICANT: t�%Ajeck' <br /> Vlt V.I%g 1,, BUSINESS/AGENCY: mil(R)r h`/9oyS WWWNYhOe4 <br /> ADDRESS: a. `a_5 0 - 141 . StTQ�F- ) �ky041 . '1 <br /> CCA- '{bol <br /> PHONE(1): 510 —O lI'10D9 PHONE(2):11`y — 345 _9q FACSIMILE: 510- 9q1 —0013 <br /> TENTATIVE'APPOINTMENT DATE: #�- 311.9 Time: t bI0�� <br /> (Please allow 10 business days from date of application submittal-'Tentative only-muse confirmed) <br /> HECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> It <br /> SIGNATURE OF APPLICANT DATE <br /> c <br /> UNIT DISTRIBUTION ❑ Unit d2 nit3 nit ❑ Unit #4r Unit ❑ Other�`d �,ltiip*' j! <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> I. 'Jol 1p - t i ib Sk k <br /> HW U("' 0 )1 <br /> 2. %j v g Co <br /> 3. W W <br /> 4. <br /> 5. <br /> 6. <br /> 7. 11A11 23 2QO <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ,/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> CW UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Q.SOLID WASTE FACILITY/VEHICLE <br /> 1X OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY AWASTE TIRE <br /> tkUNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA SI 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 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 /> EHD 4802406 <br /> 11/23/04 <br />