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k'. EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COLj <br /> ��,C� MVEOD ENVIRONMENTAL HEALTHIRPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 !� <br /> MAY 0 3 2O10relephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd t" 1 „i <br /> ENViROINWEr:fd I HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> r L t / <br /> APPLICANT: 613 7 Get �./, - �://H� BUSINESS/AGENCY: �hGrry ,aM ir / Gt lfJ <br /> ADDRESS: 6-',A', f CITY/STATE/ZIP:Scn fp"r n c,J cam: <br /> PHONE (1): (707) d3 7-/a-C��6 PHONE (2):C�CJ ) 732-,+.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-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGI ATURE OF APPLICANT I __( / (' DATE S _ ._s' 2-O!( <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street A Street Name city ❑Unit 1 <br /> 1• <br /> -Z ,30 / M n/-Lcct �), t,F <br /> 2. 2N LuL,ia-c Elven in r c4 u4 t951) ❑Unit 2 / <br /> 3. - - <br /> 4• Z,puf �' kiK /gL^2H v-{- A'[o� k Unita <br /> 5• ` o1 LEl dL �v2n G. LrL" v2 <br /> 6. 45,?-7i Y E, Ca<.;,ct LC,tz L /V ! F 6nit4 <br /> 7. <br /> 8. _ ❑Unit 5 <br /> 9. <br /> 110. 1 ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑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 TRUCKIYARDICHEMICALTOILETS <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:OOPM(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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EHO USE ONLY <br /> EHD 48-06 8/2709 <br />