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DATE RECEIVED END LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />000 Telephone: (209) 468-3420 Fax: (209) 4640138 Web: www.sjgov.org/e d 90 <br />PUBLIC RECORDS RELEASE APPLICATION <br />BUSINESSIAGENCY: C C <br />APPLICANT: I <br />ADDRESS: OAU KJ SiKtl%j�, t City/State/Zip �5►JO LA `1-114 <br />PHONE (1): (559 111411 - I Lt SI PHONE (2): FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: OCfi�btK 22, 8 Time: 9 _ 11 P- VA, <br />(Please allow 10 business days from date of application submittal -'Tentative only - must be confirmed) <br />13 CHECK 13OX TO EXPEDITE REQUEST - b10 CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE Il} <br />Electronic Information: ❑ List[] Map -Description, <br />FILE ADDRESS EHD USE ONLY <br />Street # <br />Street Name <br />City <br />❑ Unit 1 <br />- g T 5sUnit <br />Wp' eA_Lt)O EOAQ <br />5T0Ck/_�� <br />2 <br />113. <br />- <br />-- <br />unit 3 <br />4. <br />�• <br />Unit 4 <br />6. <br />7. <br />❑ Unit 6 <br />8. <br />g, <br />10. <br />[] Unit 6 <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />I;0 UNDFROROUND TANK (UST) CLEANUP SITZ= (LOP) ❑ HOUSINO ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br />19 OTHER CLEANUP SITE (NowLOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br />RI UNUEROROVND TANK (MONITORINOIREmOVAL) ❑ Doo KENNEL M DAIRY � ,y <br />10 HAZARDOUS WASTE GENERATOR �( ❑ CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT ��' / �G� d <br />❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOo/9oDY PIERCING 13 PoOL/SPA 0 LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR Rl'VIEw - MONDAY -FRIDAY 11:00 AM -6:001"M - EXCLUDIW HOLIDAYS. <br />1. List up to tan 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 indlcaited above. Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after <br />3:00 prn 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. Anew application maybe <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 $105 deposit prior to review. <br />END USE ONLY <br />I • d ZSb 1 -Ga2- GSS- 1 JJ03 ez T as e.Ija t S efrs : T T 80 tb T '400 <br />