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DATE RECEIVED tl1U LVii NU11fStitK <br /> EN1SAN JOAQi1IN COUNTY <br /> t0NMENTAL HEALTH DEPARTIIINT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2705 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.orglehd 5 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: [[�� `C k MS n L t� BUSINESSIAAGENCY: MIME 6T D D�'� �/1'�y�>�j"�(lY" <br /> ADDRESS,- d w-5 3 �l tY Q'c.1' <br /> PHONE(1): `O zJ�I -� r1 PHONE(2):-1 1q — 345 `CI°I FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: liftf � Time: 1C) <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> HECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE '� d S <br /> R <br /> UNIT DISTRIBUTION ❑ Unit 1 It 2 nit 3 nit 4 ❑ Unit 5 Unit 6 ❑ Otheyil 1_,s�I 1 <br /> � !71. ,. <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 3. W LA <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Od UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT CKS OLID WASTE FACILITYIVEHiCLE <br /> CX OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY .WASTE TIRE <br /> �kUNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY © MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOL/SPA .5 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:OOPM - 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 EMD 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 48-02-006 <br /> 19!23104 <br />