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DATE RECEIVED t LUCi u <br /> SAN,IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 Last Weber Avenue,3r4 Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Pax:(209)464-0138 Web:www.sjgov.org/e <br /> ZOOS APR I I AM 950 <br /> PUBLIC RECORDS RELEASE APPLICATION - <br /> APPLICANT: rA ---ritj BUSINESWAGENCY: L t f UN i`Y <br /> ADDRESS: f !~' T 1 t7 EP A R 7Hr <br /> �, <br /> PHONE(7}:, i�E�'�, 114/2� PHONE(2}:, � �� � FACSIMILE: MWOO <br /> TENTATIVE`APPOINTMENT DATE: Time: i <br /> {Please allow 10 business days from date of application submittal-'Tentative only-must be confirm <br /> © CHECK BOX TO EXPEDITE REQEST-$93.00 F ASH OR CHECK ONLY)—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �/! /dC //2 1&-IGC _DATE <br /> UNIT DISTRIBUTION ❑Unit 1 E3 Unit 2 ❑ Unit 3 fJ Unit 4 ❑Unit 5 ❑ Unit S ❑ Other(electronicAistVmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 343- <br /> 4. <br /> 5. <br /> 6. 1 V Iluill- MEE <br /> 7. <br /> 70. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMEAT FILES <br /> I UNDERGROUND TANK(UST)CLEANUP SME(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVFHiCLE <br /> 0 OTHER CLEANUP SITE(NON4-OP) 0 FOOD FACIUTY ❑WASTE TIRE <br /> Id UNDERGROUND TANK(MONiTORINGJRFMIOVAL) ❑DOG KENNEL 0 DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERIAITTEDFACIUTY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEmTOILETS <br /> 0 TATTOOIBODY PIERCING ❑POOLISPA 0 LAND USE APPLICATION SITES , <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERM(T RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY B:00 AIA-5:00Pu - 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 /> EAD"42-000 <br /> i 7R]!W <br />