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of <br /> DATE RECEIVED SAN JOAQUIN COUNTY tnu LVh rvumetH <br /> REC rcN b) ENVIRONMENTAL HEALTH DEPARTMENT 350 <br /> u 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> �pR <br /> q2055 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.or hd <br /> 7 <br /> EN\4�p,OWENI HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �/fI •\ BUSINESS/AGENCY: <br /> ADDRESS: i.��3 LV, M4lzt'f3 L/V 4--7— `` S-009�Atl « , <br /> PHONE(1): OV -3006 PHONE(2): �Y _Vo o4 FACSIMILE: 510 X46�" T <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-$9 Oq IFEE( SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT r DATE `� 7 -©S <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 nit 3 ❑ Unit 4 nit 5 ❑ Unit 6 ❑ Other(electronidlistslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. yw3 --WAVY Pe 5 rCxre <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. ARM <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From f �S to OS <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) 171FOOD FACILITY 0 WASTE TIRE <br /> DERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> RDOUS WASTE GENERATOR E3CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 11 MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> OFF-I❑TATTOO/BODY PIERCING ❑ POOLISPA O LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY 11 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted -for additional assistance with file addresses, contact <br /> the EHD. Applications received after 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 <br /> approximately ten (10) days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be submittecl'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 <br /> applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> EHD AIM2-006 <br /> 1H4l06 <br />