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'=2 Ij l SAN JOAQUIN COUNTY , <br /> 7, <br /> ENS `ONMENTAL HEALTH DEPART r ` <br /> ��'IJ 66-dEast Main St. Stockton, CA 952002 <br /> F..- lephone: (209) 468-3420 Fax: (209) 464-0138 We ROw sjgOV.Org/ehd a <br /> CL PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 11b L ' 1 .7-(-e- C) BUSINESSIAGENCY: <br /> ADDRESS: --3r,h S+c 2-CO CITYISTATEiziP: CcZf i�,- Me 5 C ;C,N,6) (.42 <br /> CJ <br /> PHONE(1): 0— tP - � PHONE (2):rJ- i0-�9g5—�oZcl3 FACSIMILE: 510-29,5- 2(05 <br /> TENTATIVE*APPOINTMENT DATE: F1''A 2 2 b) U Time: PYV) <br /> (Please allow 10 business days from date of application sub 1- Tentative only-must be confined) <br /> HECK BOX TO EXPEDIT=-$115 SH OR CHECK ONLY)-REQUEST PROCESSED 1N 3 BUSI ESS D YS <br /> SIGNATURE OF APPLICA DATE <br /> Electronic Information: 3 List XMap- scription: 777 77 777 ✓r u ✓1 77 <br /> FILE ADDRESSQ� + EHD USE ON <br /> L <br /> Street# Street Name City <br /> 'F ❑Unit 1 <br /> 1. 20 I Cj t h Scl�'j 0-" E <br /> 2. 7 77- �S ")`djr'" .. Unit 2 <br /> 3. r:r <br /> � :. <br /> 4. � ]Unit3 <br /> 5. <br /> 6. <br /> 2 ,.— <br /> Z �►'1 Unit 4 <br /> y. 11301 <br /> 110. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From ("\7 C'77 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILFIYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY RWASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> IKIIERED PERMITTED FACILITY ❑MOTELMOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ 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)4640138 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 4808 <br /> 8127!09 <br />