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DATE RECEIVEDSAN JOAQUIN COUNTY EHD LOG NUMBER <br /> `-=� <br /> Jf <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd �� J <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:. g BUSINESS/AGENCY: 6,01(a-n <br /> ADDRESS: `1 (- � (Wulfro AW4 svtk-,lox CITYISTATE/ZIP: Xa <br /> PHONE (1): Z01 1-1S_— t7162? PHONE (2): Z6 L31-ZOO Y FACSIMILE: 265 Y:K- r/d t- <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE RE $125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE `f.7.A. <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 2. ❑ Unit 2 <br /> 3. <br /> y Id L <br /> 4. i1 Z52-9, 21g-b fit 6 C7 ,�J Unit 3 <br /> 5. ***PLEASE RESPOND AS SOON AS POSSIBLE. I tf-•+'�- <br /> g I NEED TO NOTIFY APPLICANT DURING I �I��Q��� vita <br /> 7 WEEK OF 5/14/12 IF EHD HAS FILES FOR) <br /> tth <br /> LISTED ADDRESSES OR NOT. <br /> 8. ❑ Unit 5 <br /> 9. <br /> 10. ElUnit 6 <br /> Specific Date Range of Information.Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> RUNDERGROUND TANK(UST)CLEANUP SITE(LOP) [:1 HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> [OTHER CLEANUP SITE(NON-LOP) F]FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> aHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ['}TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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 appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses, contact the EHD. Applications received after <br /> 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 approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> 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 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 the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> 5 64 <br /> k - � 7 r <br /> ' n titer <br /> EHD 48-06 ' 811111 <br />