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DATE RECEIVED -SAN JOAQUIN COUNTY trlu wU numatrc <br /> `..� <br /> U ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> mAt 2 6 ?0055 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> EtdVIRQN /SERVIC HEALTH <br /> PUB RECORDS RELEASE APPLICATION <br /> S <br /> APPLICANT: iZ0t> BUSINESS/AGENCY: \/EIZ4x <br /> ADDRESS: f-1-1_10 I�444---Wn t 6 -r IZDAb S-7?{ fz�A_ _T42-vi^j E '34 <br /> PHONE(1): � � 608 —C-1910 PHONE(2): FACSIMILE: 4" 6 C& <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 REQUE -$93.0 E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z6�S 'voa <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2L nit 3 nit 4 Unit 5 Unit 6 13 Other(electronic/lists/maps) 0 <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> A. ZbZ 5 E_ W VE, 4 <br /> 2. 03-T_S _ d\)E3fYL -►E` C�To�I <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> A, UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT SOLID WASTE FACILITY/VEHICLE <br /> ,OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> vCHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑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 <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,contact <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 submitte'd'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 /> EHD 48-02-006 <br /> 1/14105 <br />