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EHD LOG NUMSERP <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH D15PARTMENT <br /> 600 East Mai�n St. Stockton, CA 95202-3029 <br /> hone; (209) 468-3420 Fax.- (209)464-0938 Web: WWW.SjgOv.org/ehd ' <br /> Ll V; E <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; A'yWV&r% --LN:% BUSINESSIAGENCY: <br /> ADDRESS: 3glA <br /> % CITYISTATEIZIP. <br /> PHONE(1): % -6 to PHONE'(2): (SU) -SsAe FACSIMILE: if.) qfW _V,�pS <br /> IVE*APPOINTMENT DATE: d <br /> rFNV"AVF!APPnINTM1zIIT�n, <br /> From 010A of apill-�60n-.�bfdtal-�Tnttj.Only-must be confirmed) <br /> ❑ Time: <br /> (Please allow 10 business days <br /> A <br /> ; <br /> CHECK aOX TO EXPEDITE REOUES -$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � DATE— <br /> bectrionic Information: ❑List El Map—Description: <br /> FILE ADVIRESS I EHD USE ONLY <br /> Street# Street Nome city <br /> E71 unit 1 <br /> qIto fK4U1r1qL( <br /> 2. +%t E) <br /> 3. Unit 2 <br /> 4. 0r355 ill -J <br /> _!% V.L., <br /> If - <br /> S. <br /> 7r <br /> s. <br /> mum _4 <br /> 7. <br /> Unit 5 <br /> 10, <br /> 0 Unit 6 <br /> Specific Date Range of Information Reoiuosttd: From to pww-4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> [A UNDERGROUND TANK(UST)CLEANUP SHE(LOP) ❑HOUSING ABATEMENT ❑SOLM WASTE FACILITYNE41CLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑Fool)FACILITY El WASTE TIAL <br /> UNDERGROUND TANK(MONITORINGIREmovAL) E]DOG KENNEL El DAIRY <br /> HAZARDOUS WASTE GENERATOR C]CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> El TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDIGHEMICAL TOILETS <br /> El TAT=/BODY PIERCING ❑POOLISPA El LAND USE APPLICATION SITES <br /> El MEDICAL WASTE FACILITY FKI OTHER(PLEASE SPECIfY) <br /> q <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW, MONDAY-FRIDAY 8:00 AM-5:OOPM(ExCLUDINc3 HOLIDAYS) <br /> i. List up to ten alftaln in the space above. Select the type(s)of flies from Ke I listabove by checking the appropriate <br /> box(es). At least one file type MUST he selected. Fax to{2091464-0­138 or mail to address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Aepilwtions received after <br /> 3:00 pm will be processed the next business day. 'i <br /> 2. The EHD will noft the applicant if any EHD files exist. An appointment for review will be confirmed approximately ton(10) <br /> days after receipt of application. The flies will be h old for a maximum of five business days for review. Appointmentsshould 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 /> I <br /> 4. Any file not returned in the Verne condition as released will be reorganized by EHD Staff at the experiss.of the applicant. <br /> Future file reviews by the same applicant may riatitkire a$122 deposit prior to review. <br /> F140 USP(WIN <br /> EHD 48-00 <br /> dA, arhenn <br /> opv-cr' wj",*VA LASIs I&T-4, <br /> [00/1.0018 XVj 0I.Oz/ol./60 <br />