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r <br /> DATE RECEIVED EMD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov. d <br /> PUBLIC RECORDS RELEASE APPLICATION ( <br /> APPLICANT: BUSINESS/AGEN(;Y: r.NST{ <br /> At)ORESS: S'3b <br /> City/State/zip Iti b ti Ce– r6 P) _ <br /> PHONE(1): �U� ��� �1oDa PHONF-(2); ZO9 37-t 71,66 FACSIMILE, F <br /> TENTATIVE"APPOINTMENT DATE. 1 2-- <br /> ~0 Tlma: F-3�3 _ <br /> (Plsase allow 10 business days from dato o application submittal-"rentat/ve only-must be confirmed) <br /> CHECK BOX TO EXPEDITR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> E REQUE OS F A <br /> SIGNATURE OF APPLICANT DATE _ D <br /> Electronic Information, © ListE] Map—beseription: <br /> FILE ADDRESS EHD USE ONLY <br /> Stroet# Street Name City <br /> o14 G ac f a I Unit 1 <br /> - RVe. N_ t � a <br /> 2. as �' ❑ Unit 2 <br /> 3 <br /> 4. a� D �� S. S fn C _ �S�P Unit 3 <br /> 5. <br /> 6. — Unit 4 (� <br /> 8 ❑ Unit 5 <br /> 9. <br /> 90 ❑ Unit 6 <br /> Specific Data Range of Information Requested:From to O/t'J(AJ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> fi UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> MOTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> 04 UNDERGROUND TANK(MONITORING/REMOVAL) CI DOG KENNEL 0DAIRY. <br /> 01HAZARDOUS WASTE GENERATOR R CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY C]MOTELIHOTEL I7 PUMPER TRUCK/YARD(CHEM TOILETS <br /> ❑TATTOO/BDDY PIERCING ❑POOL/SPA 0 LAND USE APPUCATION SITES <br /> d MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AMI-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 209 464-0138 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 hold 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 some 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4$.06 8/04108 PUBLIC RECORDS RELEASE ARP FORM <br /> ZB 39dd NOdIiJ039N3 96LT66960Z TV :TT 8092/LT/ZT <br />