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----- "--""--"" ' EHD LOG NUMBER <br /> DATE RECEIVED D SAN JOAQUIN COUNTY <br /> �j C C��VO `ENVIRONMENTAL HEALTH DEPARTMEN ` ! <br /> LU 600 East Main St. Stockton, CA 95202-2708 /L4 <br /> JUN 0.' Yelephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd l <br /> ENVIRMIENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: i r `L,ll 1 rJ� p A !/ ���yl� BUSINESSIAGENCY: <br /> T <br /> ADDRESS: 3 �`! �J glr!vc 0*0 CITYISTATEIZIP: `l CIYI <br /> PHONE (1): L./-- 2900 PHONE (2): 41 Z� D<� FACSIMILE: <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-$115.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> (//„IVA`,� DATE biz 10 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# <br /> Street Name City ❑Unit 1 <br /> 1. 3SI �� l�Gvy Shy <br /> 2. o-I kU 64- AD <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7.9. <br /> 10. <br /> 44 <br /> to <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUNDTANK(UST)CLEANUP SITE(LOP) E]HOUSING ABATEMENT ❑SOCIO WASTE FACILRYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR - PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑ <br /> LAND USE APPLICATION SITES <br /> F1IBODY PIERCING <br /> POOLISPA <br /> MEDIC F1 OTHER(PLEASE SPECIFY) El❑ MEDICAL WASTE FACILITY <br /> ima= <br /> DSEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> o ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> . At least one file type MUST be selected. Fax to(2091 464-0138 or mail to the address indicated above. Address <br /> will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> will be processed the next business day.D will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> er receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> 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 nssistancelease contact Diane Martinez direct) Cz (209)468-3425. Thank You** <br /> FHII dPJ1fi „- <br />