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DATE RECEIVED <br /> SAN JOAQUIN COUNTY 4 EHD LOG NUMBER <br /> ENV , NMENTAL HEALTH DEPARTA <br /> �1 �G,\ l 600 East Main St. Stockton, CA 95202-2708 <br /> Tglephone: (209) 468-3420 Fax: (209 464-0138 Web: —! <br /> cU, ) www.sjgov.org/eh <br /> ;,1rl,i t \1(�IPUBLIC RECORDS RELEASE APPLICATION <br /> APf 70.p[F�1( �tI�J/(� �a.v`�j J`4 �USINES�/AGENCY:c�,�✓r <br /> pp((l�` ,/ ,,[,���� S S�PiaS �uC <br /> ADORESb`: Fi'SS f �YY1Cc Cl OV r �// dtLr 1Y 7� CITY/STATE/ZIP � 3 -702 <br /> PHONE (1): 2- Pry(At�IE/l2): �Ci�- 3�� �f3jZ FACSIMILE: 2,9 �jl{S -q� S' <br /> C�yJ 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-$115.00 FEE(CAS R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 0' /.3 !O <br /> 7 <br /> Electronic Information: ❑ L' ap-Description: <br /> Z <br /> I FILE ADDRESS tqo, EHD USE ONLYit <br /> Street# Street Name City /'F- <br /> ❑Unit 1 <br /> 1 25/03 Yk7a. 'kee< /r9DAK <br /> 2' d L.OU?L2141lAe, -73.24,. dye R <br /> 3. Unite <br /> ,) Z <br /> \^' l <br /> an tart-C TTu-c 2 ,/r ac l�Yt�ova -tet �V <br /> 4. <br /> 5 Unit 3 <br /> 6. <br /> 7 nit 4 <br /> 8. <br /> ❑ Unit 5 <br /> `J 9. <br /> J 10. <br /> Specific Date Range of Information Requested: From 1220 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> p )UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br /> lVAVIOTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ®WASTE TIRE <br /> ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH u��S [:1 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY <br /> ❑MOTELIHOT dG� �, ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING POOLISPA LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY OTHER(PLEASE SPECI T ' <br /> WELL AND PEPTIC PERMIT RECORDS ARE AVAILABL���E"`FOR REVIEW MONDAY-FRIDAY 8:00 AM-S: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$115.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance please contact Diane Martinez direct) @ (209)468-3425. Thank You*** <br /> FMII dPN. <br />