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DATE RECEIV-r_D EHD LOG NUM;i R <br /> '�11f; �} SAN JOAQUIN COUNT'S <br /> EN"RONMENTAL HEAL'T'H AEPARTNIENT <br /> 304 East Weber Avenue,3"d Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Falx: (209)464-0138 Web: www.sjgov,orglehdIqJ13 <br /> i `t� ti s`. S'�Tf; PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: q f lgn0&.x� 1AQAkCr%0'n _ BUSINESSIAGENCY_- C/�l ro X!vices <br /> A!]DRESS: 1S <br /> PHONE(l): �y �0 )y-5 1 1 a (.ILA.�PHONE(2): FACSIMILE: D �- <br /> TENTATIVE*APPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal-'Terrta6ve only-must be <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN�BUSINESS DA <br /> SIGNATURE OF APPLICANT DATE Cl b <br /> UNIT DISTRIBUTION L7 Unit 1 C Unit 2 ❑ Unit 3 ❑ Unit d ❑ Unit 5 ❑ Unit 6 ❑ Other(electronicfrists/maps) <br /> FILE ADDRESS <br /> Streets Street Namecity <br /> EHD USE ONLY � <br /> 1. 5 s�%�� -U� <br /> 3. <br /> 4: 1 <br /> 8. <br /> 9 <br /> .------. __ jWL14. ­� <br /> Specific Date Range of Information Requested:Fmrn f Lpc } l [.S to c-n <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Xt1NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HousiNG ASATEVENT 'ia SQUAD WASTE FAcfLmrIVEK1CLE <br /> OTHER CLEANUP SITE(Nom-LOPI ❑FOOD FACILrrY 0 WAs'rE TIRE <br /> UNDEf2GFtOUFIDTAIJK{MQ'NITO#trNGIREMOVAL) C]Doo KENNEL qAu <br /> DRyHAZARflOUS wA57E GEHERATDR ElCHICIIEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> '❑TIERED PERMrrrEO FACILRY ❑MIOTELIHOTEL ❑PuunRTRUCKIYARDtCHENITOILm <br /> ❑TATTQo1BODY PIERCING CI POOLt'SPA 0 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 177 OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMrr RECORDS ARE AVAILABLE FDR REVIEW • MC)NDAY-Fm"8:00 Aqd:00pM - EXCLUDING HOLIDAY$, <br /> 1. List up to ban addresses in the space above. Select the types)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, con# <br /> Che EHD.Applications received after 3:00 prn 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 /> 9 <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 /> E -0o <br /> i11ifQ5 <br /> I-d 9Zt£-L4b (48v) do4 Zl 90 0Z d@S <br />