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1 <br /> EHD LOG NUM3ER <br /> DATE f�RECEIVED SAN JOAQUIN COUNTYI 3D <br /> f an4�,�l� is <br /> r ENVIRONMENTAL HEALTH DEPARTMENT <br /> "r v 304 East Weber Avenue,3'd Floor, Stockton, CA 95202-2708 <br /> p\ ^•i� } (_105 7'elephone: (209)468-3420 Fax:(209)464-0138 Web: www.sjgov.org/ehd <br /> lqql3 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C BUS[NESSIAGENCY: Al— <br /> ViC�S <br /> ADDRESS: v i�, L; H t ri S cdc "ZS1 <br /> PHONE(1), ����$ 1 �? PHONE(2): FACSIMIi.E: C� 51__3 C� <br /> TENTATIVE`APPOINTMENT DATE: <br /> (Please altow 10 business days from date of application submittal 7renta6ve only-must be c n6 D <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$9D3.00 FEE(CASH OR CHECK ONLY]-REQUEST PROCESSEIN 3 BUSINESS DA <br /> SIGNATURE OF APPLICANT `� LDATE GI 11 a b - <br /> UNIT D15TRIB ITIO_ ❑ Unit i ❑ Unit 2 ❑ Unit 3 ❑ Unit 4 0 Unit 5 ❑ Unit 6 ❑ Other(elecironiclrsatslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City _ <br /> l <br /> 4. <br /> -6. <br /> 7. - <br /> ,, I <br /> 5• _�---- - - - --— <br /> 10. <br /> Specific Date Range of Information Requested:From _ e C 1 ( S to jl <br /> ENVIRONMEWrAL HEALTH DEPARTMENT FILES <br /> �NOERGROUHD TANK(UST)CLEANUP SITE(LOP) 13HouSv rs ABATEMENT El WAST E FwerLrrYNEHICLE <br /> OTHER CLEANUP SrM(NON4-OP) C1 FOOD FACILITY ❑WASTEiRE <br /> TVIRE <br /> UNDBIGROU*IT TANK(UowrTARINCIREWVAL) ❑DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE,GENERATOR ❑CHICKEN RANCH 0 WASTEWATER TREATMENT'PLA14T <br /> ❑TIERED PERMrrTFo FACILrrY Cl MOT M PUMPER TRuCKIYARDIGHEM�roILETS <br /> ❑TATTOWBODY PIERCPNG ❑POOLISPA d LAND USE APPucATIOH SITES <br /> ❑METIGAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WDLL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FAR>;MEW - MoNDAY-FRmAY 8:00 Ali-5:00PM - EXCLUDMG HOtADAYS. <br /> 1. List up to ton 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, con <br /> tj <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 /> Ee+D u-0saoa <br /> aura s <br /> L d SLt7£-LSb (090 d06:Z6 50 06 daS <br />