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I I/LS/CVV8 IJ :Sr F A x X001/001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN .lOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/e 3d <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BoM BUSINESS/AGENCY: _( ty.Y7° e) )( C <br /> ADDRESS: nk Ay'e l 4P. City/Sitatelzip <br /> PHONE(1): PHONE(2): FACSIMILE:1 �1 ,1 <br /> TENTATIVE"APPOINTMENT DATE: Time: I I Y�-�l�I <br /> (Please allow 10 business days from date of application submittal-"Tontattva only-must be con(Irmed) <br /> CHECK BOX TO EXPEDITE RE T- S FEE(CASH O CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS AYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List[] Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. Nr coc_k�o►� 01 u , <br /> z. arl� ISA- n 3 5a Urit z <br /> 3. <br /> 4. <br /> in <br /> Unit3 <br /> 5.6- Spj(l ,, , F <br /> / Unit 4 <br /> $. ' r U 5 <br /> 9, <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested:From {-i� r��Q_�L to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERDRAUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br /> OTHER CL[ANUP SITE(NON LOP) FOOD FACILITY WASTE TIRI: <br /> L?kUNDERGROUND TANK(MONITORINCi/REMpvAL) DOG K!!NNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 9WOTELIFICTEL PUMPER TRVCK/YARDICHEM TOILETS <br /> TATTOOIBODY PIERCING ?:-POOL/SPA D USE APPLICATION SITES <br /> MEOIGAL WA8TE FACILITY OTHER(PLEASE SPECIFY) L I T1 '� <br /> WELL AND SEPTIC PERMrL RECORD$ARE AVAILA9LE FOR REy1Ew - 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 flies 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8/04108 PUBLIC RECORDS RELEASE APP FORM <br />