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"' •'�'•'-""•"' tr1U LVIi NUMBER <br /> JOAQUIN COUNTY <br /> ENVIl__NMENTAL REALM DEPARTMEN, <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd 2ZI <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: � D T/lyi`ro�rr�t� � 1-nC BUSINESS/AGENCY: <br /> ADDRESS: n <br /> CITY_ C��)L� �>1c3 STATE C�l <br /> PHONE(1): S-1 b 6 51� 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 /> 13 CHECK BOX TO EXPEDITE RE EST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE U� <br /> Electronic ❑ <br /> Information List 11Map-Description <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City y <br /> r1l 0 1- N El Unit 1 <br /> 2. 7 1 S nl r i� W.tin kr �, <br /> 3. /V or-4th ❑ Unit 2 <br /> 4. <br /> 6: Unit 3 <br /> 7. �unit 4 <br /> 8. <br /> 9. ❑ Unit 5 <br /> . 10. 1 ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M,'U�ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br /> L�-T U�T ER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> L- NDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> �AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 11 TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑ TATTOO/BODY 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-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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD. Applications received after 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 <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> rt <br /> V <br /> EHD 48-OG <br /> 10/31/2005 <br />