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( 08/10/2011 16:4TFAX_ TREADWELL & ROLLO [a 001 <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> AU Lu ENVIRONMENTAL HEALTH DEPARTMENT <br /> ep600 East Main St. Stockton, CA 95202-3029 <br /> �jw� <br /> T hone: (209)468-3420 Fax: (209)454-0138 Web: www-sjgov.org/ehd {(/ <br /> I=NWA <br /> �� PUBLIC RECORDS RELEASE APPLICATION TTT <br /> APPLICANT: I10�^, .ML \iLwp BUSINESS/AGENCY:- I Pv.otiwp_(� 4- FeL <br /> ADDRESS: SSS /VLorlp o� 13 O D CITY/STATE2IP: S [ .4 g H I 1 <br /> PHONE(1): 1 4�r- .$ Z 6 PHONE(2): FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: q, zr- l l ___ __ Time: Il aw. <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE R ST-S CASH OR CHECK ONLY)-REQUEST PROCESSED IN a BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE�� C9 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> [4. <br /> 0 . o294,D <br /> unit2 <br /> Unit 3 <br /> 6. - ,yJ Unit 4 <br /> 7. <br /> 8. ❑Unit S <br /> 9. <br /> 10. Unit <br /> Specific Date Range of Information Requested: From — I C{6 to L"rr-p—'{— <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT [9 SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS 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 /> Ll MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the typa(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(208)464-0136 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$122 deposit prior to review. <br /> EHD ase ONLY <br /> EHD 49-UG eT/39110 <br />