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fi <br /> 4 <br /> Ib-AI'7fE f2C•CE�VED .� 11= -� _ <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> /007 600 East Main Street;Stockton, CA 95202-3029 <br /> Telephone: (209)4683420 Fax: 209 464-0136 Web: wvnvsjgov,org/ehd <br /> 1 C NI r;;�I7 - 3079 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> A BUSINESSIA/GENCY: <br /> ADDRESS:_ ,I v�A ZII <br /> PHONE(1): q�5 a 7-QGf PHONE(2): <br /> FACSIMILE:_. k75 GIA/,{ 7fr9C <br /> TENTATIVE`APPOINTMENT DATE: " l <br /> (Please allow 10 business days from date of aPP ttal Ilcatlon sub-; •'Tentetiva only. <br /> .m <br /> must be conFirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-S98,00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE j <br /> Electronic Information: ❑List E] Map—Description: <br /> i <br /> FILE ADDRESS END USE ONLY <br /> Street# Street Name City <br /> unit, <br /> 2.3. UmI <br /> tf <br /> f <br /> 4. nit3 <br /> 6- unite <br /> 8. ❑ Unit 5 <br /> 9 ! <br /> unit <br /> I <br /> Specific Date Range of Information Requested: From to <br /> I <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> t)I�DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT M SOLID WASTE FACILITYNEHICLE <br /> C/ HFR CLEANUP SITE(NDN-LOP) El FOOD FACILITY ❑WASTE TIREE,VI <br /> 0 DDERGROUND TANK(MONITORINOIREMOVAL) C3 DOG KENNEL ❑DAIRY <br /> 13 HAZARDOUS WASTEGENERATOROR dCHICKEN RANCH - Cl WASTEWATER TREATMENT PLANT <br /> •TIERED TT PERMITTED FACILITY ❑MOTELIHOTEL LI PUMPER TRUCK/YANDICREM TOILETS <br /> • MEDICAL WASooy PIERCING ❑POOIISPA 17 LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORD$ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 11;00 AMS:OePM - ExCLUDING HOLIDAYS. I <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the Ilst 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 fila adtlresses,contact the EHq.Applications received after ` <br /> 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant if any END files exist. Ana pi for review will be confirmed approximately ten(10) <br /> days after receipt application. The files will be held for a maxaximumum o of flue business days for review. Appointments <br /> should be scheduled accordingly. - _ <br /> 3. A file that is actively being worked on by END 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 some condition as released will be reorganized by END staff at the expense of the applicant. I <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> END USE ONLY <br /> EHD 4"a W EU weO09 <br /> T9 3OVd TV8Z85L9TFT L0 :59 L99Z/BT/68 _� <br />