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a <br /> DATE RECEP/ED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 R <br /> 2w <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Wwww.sjg ch <br /> eb: v <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: rr' \tJ BUSINESSIAGENCY: 3 UIUJ g <br /> ADDRESS: �69 N , L L.. �-i196k&6 �� <br /> PHONE(1):U6T(o_ S? I PHONE(2): FACSIMILE: <br /> TENTATIVE'APPOINTMENTDAT Time: <br /> (Please allow 18 business rom date of application submittal-'Tentative only.must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE E -598.00 ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 41 44 <br /> Electronic Information: ❑L ❑Map scription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ units <br /> 2. ❑ Unit 2 <br /> 3. <br /> -- -- - Unita <br /> 4. <br /> re 11Ubnit4 <br /> s. <br /> �• A uh n :��A <br /> ❑ Unit 5 <br /> 9. ❑ Unit 6 <br /> 10. <br /> 5. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> E3 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 0 SOLID WASTE FACILTFYIVEHICLE <br /> 13 OTHER CLEANUP SITE(NOWLOP) E3 FOOD FACILITY ❑WASTE TIRE <br /> ,A�r.N./�\U�NDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL El DAIRY <br /> AURDOUS WASTE GENERATOR 13 CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑PUMPER TRUCKIYAROICHEM TOILETS <br /> •TAVMA30DY PIERCING 13 POOJSPA O LAND USE APPLICATION SITES <br /> •MEDICAL WASTE FACILITY 13 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 appropria <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the address indicated above. Ad ess <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD.Applications received er <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant N any EHD files exist. An appointment for review will be confirmed pproxim y len(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for revi . App ' tments <br /> should be scheduled accordingly. <br /> 3. A Nle that is actively being worked on by EHD staff may not be immediately available for review. application may be <br /> 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 th xpense of applicant. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> etA r/' <br /> EHD Y-06 WEB 8IBR00T <br />