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!,:=3�� �. SAN JOAQUIN COUNTY <br /> Imo,• <br /> ENS" ONMENTAL HEALTH DEPART. <br /> '2 a LUIJ 6bAast Main St. Stockton, CA 9520 <br /> ephone: (209) 468-3420 Fax. (209) 464-0138 We w w.sjgov.org/ehd <br /> �Lri,"z;� ; ','ILS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: l ' ` .�'�-P C BUSINESSIAGENCY: <br /> ADDRESS: S 4,4h , S-'C 2W CITY/STATE1ZIP: COSH ���SCn W-I UP Z <br /> PHONE(1): 610—9 CP - � PHONE(2�): 510-&95-�v2•- 0 FACSIMILE: 510-2 � 5- 2(05(� <br /> TENTATIVE'APPOINTMENT DATE: Priam 2 2() v Time: <br /> (Please allow 10 business days from date of app ca'on sub 1 Tentative only-must be confirmed) <br /> HECK BOX TO EXPEDITE REQ T-$115 SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUST ESS DAYS <br /> SIGNATURE OF APPLICA DATE 0 <br /> Electronic Information: 0 ListXMap- scription: N/b ✓v-o n��r ✓1 �� <br /> FILE ADDRESS41 Q� EHD USE ONL <br /> Street# Street Name City <br /> El Unit 1 <br /> 7. <br /> 4 <br /> 2. 7- l] �.� moi- %� 1N Unit 2 <br /> 3. <br /> 2 Q �y <br /> 4. J � �'1_� �, •`°.'`„°4 "�, unit 3 <br /> 5. <br /> 6. ZZS VL a: �Y + '1 )Y--\ C Unit <br /> 8. 02� �- , t- 1�(� (� e �l ❑Unit 5 <br /> 9. <br /> 10. <br /> Unit 6 <br /> Speck Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> lk[UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br /> I <br /> THER CLEANUP SITE(NON-LOP) El FOOD FACILITY WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL F1DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMiCAL TOILETS <br /> ❑TATTOOBODY PIERCING ❑POOL/SPA ❑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-5:00PM(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 48.08 <br /> 8/27109 <br />