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v411U/2013 27:44 Fax <br />BATE RECEIVED EHD LOG NUMBER <br />SAN JOAQUIN .COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3rd Floor, Stockton, OA 95202-270 <br />a <br />20107 Telephone: (209) 468-3420 Fax: (249) 464-0138 Web: www. <br />sjgov.orgl d <br />`_4,:, L1 PUBLIC RECORDS RELEASE APPLICATION <br />'A F ;_oil f Ii <br />APPLICANT: $USINESSJACIENCY: r �' <br />ADDRESS: SR <br />PHONE (f): all O PHONE (2): FACSIMII-i4; 1 <br />TENTATIVE* APPOINTMENT DATE: - S l Sty7 —] TimQ: <br />(Please allow 10 bus)neSS days fromrri datd of application submittal - •Tenlafivs only -must be confirmed) <br />❑ CHECK sox Td ExPEDITE REQUEST 495-00 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATI= S111 -off <br />Electronic Information: ❑ List © Map - Description: <br />to <br />_ <br />street 0 <br />FILE ADDRESS EHD, USE ONLY <br />id 6ND9RGR0uND TANK (UST) CLEANUP SITE (LOP) <br />Stnmt Nam9 - Clay Q Unit 1 <br />1 _j 11-'*_...: a (Ag�. +�► Sf . - a S �5a a unit Z <br />Iii , <br />I a DJr. . Sa� �unit3 <br />ab <br />a� " <br />❑ Unit 8 <br />Unit 5 <br />i' <br />1 <br />❑ FOOD FACILITY <br />C3 WASTE TIRE <br />3. <br />y ti <br />4.. <br />jII i <br />0 CHICKEN RANCH <br />0 WAsTEwATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY <br />C1 MaTEL/HOTEL <br />7. <br />d TATTOOIeoDY PIERGmNG <br />6 POOLISPA <br />0 LANb USE APPLICATION SITEs <br />LO, <br />CI OTHER(PLEAS%SPECIFY) <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT FILES <br />id 6ND9RGR0uND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />'ilk SOLM WASTE FACILITYIVEHICLE <br />6 OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />C3 WASTE TIRE <br />Of UNDERGROUND TANK (MONITORING/REMOVAL) <br />I7 DOG KENNEL <br />1'.I DAIRY <br />HAZARDOUS WASTE GENERATOR <br />0 CHICKEN RANCH <br />0 WAsTEwATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY <br />C1 MaTEL/HOTEL <br />0 PUMPER TRuoK/YARmNCHEM TOILETS <br />d TATTOOIeoDY PIERGmNG <br />6 POOLISPA <br />0 LANb USE APPLICATION SITEs <br />❑ MEDICAL W45TEFACILITY <br />CI OTHER(PLEAS%SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDs ARE AVAILABLE FOR REVIEW - MONDAY-FRIgAY 8:00 AM-6.00PM - ffX&UCiNG HOLIDAYS. _ <br />I., List up to ten addresses In the space above. Select the type(s) of files from the flat abOvo by checkino the appropriate <br />'box(es). At least one file type MUE.T be selected. Fax to (2091464-0138 or mail to the address Indicated above, Add rese <br />i ranged will not be accepted - far 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 />,'daye after receipt of application. The files will be held for a maximum of five business days for review. Appolntrnents <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 Hie is available. <br />4..Any file not returned In the same condition as released will be reorganized by END staff at the expense of the applicant. <br />Future file reviews by the same applicant may requlte a 995.00 deposit prior to review. <br />EIHD USE ONLY . <br />eNn ae-os 14+2006 <br />