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i <br /> IbAIYE ftE(,EIVEC . !,iL, i -EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONAIENTAL HEALTH DEPARTMENT <br /> [LOi 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3430 Fax: (209)464-0138 Web: wwws ov.Cr (ehd <br /> rrc rr�,/I,,�O�,ME Hr 301PUBLIC RECORDS RELEASE APPLICATION . <br /> . APPLICANT: <br /> ADDRESS: BUSINESSIAGENCY: R'St /',tH�<at4d'4d t#'d� <br /> 1 <br /> ..2Sn(, <br /> Amt w�i�ata b/rs lea 0 to f 4- l rwL l2,elr 44,,S2gq4 <br /> PHONE(1 J: Z 5 i-r `Lf PHONE(2) - FACSIMILE:_ q Z 5 <br /> - w 7 q <br /> TENTATIVE'APPOINTMENT DATE; Time: <br /> (Please allow 10 busmeBs days from date of application submittal-"Tenrative only.mu.t ba---firmed) i <br /> n CHECK BOX TO EXPEDITE REQUEST-598.00 FEE(CASH OR CHECK ONLY).REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> SfreatA Street Name City - <br /> ❑ Unit 1 <br /> a. Ca 5 e ,,G7L� <br /> 5 <br /> 6. - Unit a <br /> t3. ❑ Unit 5 <br /> - - <br /> 10. - - ❑ <br /> Unit s <br /> Specific Date Range of Information Requested: From to <br /> 1 ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I�Uri ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT b SOLID WASTE FACILITY/VEHICLE <br /> ,EER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> d{NTDERGROUND TANK(MONITORINOIREMOVAL) -O DOGKENNEL EI DAIRY <br /> HAZARDOUS WASTE GENERATOR MCHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY O MOTELIHOTEL L1 PUMPER TRUCK(YARDICHEM TOILETS I <br /> ❑TATToolBoDY PIERCING ❑POOVSPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY a;DO AMS:00PM - EXCLUDING HOLIDAYS. <br /> 9. 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 (2091464-0138 or mail to the address indicat d 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 recelpt of application. The files will behold for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked an 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD48Q5 WEB 8162W7 <br /> L9 39tid TbHZ86GGT8T L9 :6G L00L/GT/60 <br />