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-RECEj) EMU LUU NUMt$tK <br /> TE, IVED <br /> SAN JOAQUIN COUNTY <br /> ' <br /> ENVIRONMENTAL HEALTH DEPARTMEAT <br /> ,y LU IU 600 East Main St. Stockton, CA 95202-30 <br /> Tele hone: (209) 468-3420 Fax: (209) 464-0138 Web.: rg/ehc�4 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: (D BUSINESSIAGENCY: i__ 9 2_(0 Z <br /> ADDRESS: -A Aw e. , c Z 0 0 aryisTATEIzip: <br /> PHONE(1): 6(0-9(P4- 699 PHONE(2 FACSIMILE:(51()-,2cl 5- 265P <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of applicatirsubmittaU"Te nt"ve only-must be confirmed) <br /> CHECK BOX TO EXPEDC1TQjUE -$115 F OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU <br /> �INESSAYS <br /> SIG TURE OF APPLICA DATE <br /> Electronic Information: EL List f ap- criptkn: i\kt e-10�d�OYW�v',C <br /> FILE ADDRESS EHD USE 0 <br /> Street# Street Name city Unit I <br /> Unit <br /> 2 <br /> 2. IQ acl_� eUnit 2 <br /> 3. <br /> U <br /> lid <br /> 4. 0 NQ 0-c.,i Ck v e- unit3 3 <br /> 5. 3 S 4-cc.k.f o /\v e- <br /> 6. U,il:4 <br /> L) <br /> 7- 121V(? <br /> L8. 22--700 Q Unit 5 <br /> LQ I+Lk) 9 1 <br /> . <br /> . I - <br /> 10. "tz?� �Unit 6 <br /> Specific Date Range of Information Requested: From P CL_ r e to ZyAese <br /> ENVIRONMENTAL MALTH DEPARTMENT FILES I <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) n HOUSING ABATEMENT ZFSOLID WASTE FACIUTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) El Foot)FACILITY [j WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) El DOG KENNEL El DAIRY <br /> ,*HAZARDOUS WASTE GENERATOR F1 CHICKEN RANCH �WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MoTELIHOTEL MPER TRUCKIYARDICHEMICAL TOILETS <br /> n TATTooffioDy PIERCING ❑POOLISPA rl LAND USE APPLICATION SITES <br /> F-1 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 /> EHD USE ONLY <br /> EHD 48-06 8127109 <br />