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)ATE RECE /ED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> // 7 <br /> I�� ENS IRO1` LNTAI, HEALTH DEPARTn1EN, <br /> 600 East Main Street, Stockton, CA 95202 <br /> liji 2007 Telephone: (209)468-3420 Fax: (209) 464-0138 Web: «ww.sjgov.org/ehd <br /> LF-NViRr_')Pdil,«,,,i i' HEl-`,L TN PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C p!AJ_G, / 'I V(_—C- t b��� <br /> BUSINESS/AGENCY: <br /> ADDRESS: Kc.&Aar —�c �---4. <br /> PHONE(1): <br /> C' '- \ PHONE(2): FACSIMILE: <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 REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE � � 0 <br /> Electronic Information: ❑ List ❑ Map— Description: <br /> FILE ADDRESS _ EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> up <br /> 2. C ` J ❑ Unit 2 <br /> 3. <br /> r, Unit 3 <br /> 4. ;J s��< 5� <br /> 5. C KL AJX fO CS S Imo- i �S�L Uni <br /> 7. 4. 33 G <br /> /f\�`-� I ("'� , ❑ Units <br /> 8. j G ''�,2 Lc:,v �, Z) i <br /> 9. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From �}7ZL I L- '� to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY I]WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) 1:1DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKNARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING ❑ POOUSPA El LAND USE APPLICATION SITES <br /> 0 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 appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 5/16/2007 <br />