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r7ROM ERRS E--!­—­-t-r, Iroc. (TMV)MAV 72 2011 15'59/ST. t5:S9lIJo-7500000470 P 1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> MAY <br /> 12 21�ephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ACMES �#R <br /> nn <br /> { V gllSINE551AGENCY: <br /> ADDRESS: CC CITY/SFATEIZIP: <br /> PHONE(1); 6 V-A14 7.188���HONE(2): ��'334 dl, FACSIMILE: -�C� tom~c _4�" 3 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-`Tenfative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$1 {C H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map--Description: <br /> FILE ADDRESS EHO USE ONLY <br /> Street# Street Name city ElUnit t <br /> 2• ❑Unit z <br /> 3. w t?5 !arb Mrs a <br /> 4. �U-It3 <br /> 5. <br /> nit 4 <br /> 7. <br /> 8. ❑Unit 5 <br /> 9. <br /> 10. 4 <br /> ❑unit 6 <br /> Specific Date Range of Information Requested: From to Art I <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LDP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL El DAIRY <br /> AZARDOUS WASTE GENERATOR E]CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOoIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•S:OOPM(ExCLUDING HOLIDAY$) <br /> 7. 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 MIDST be selected. Fax to(709)464-0138 ormall 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$122 deposit prior to review. { <br /> EHD USE ONLY <br /> EHD 48.46 o72eNn <br /> f <br /> } <br />