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I i/L�)/LVUU IJ b( FAY, X001/001 <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG l'_ .IBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephon (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ed <br /> P3 <br /> UBLIC RECORDS RELEASE APPLICATION (((lll��� <br /> APPLICANT: BUSINESS/AGENCY: (Joe =n )( ( <br /> ADDRESS: City/State/21p �[-A!r <br /> PHONE(1): 'D' PHONE(2): FACSIMILE: ,1 , <br /> TENTATIVE"APPO TMENT DATE: Time: y�1�t v1 <br /> (Please allow 10 uslness days from date of application submittal-"Tontattve only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDIT RE T-$ S FEE(CASH O CHECK ONLY).REQUEST PROCESSED IN 3 BUSINESS AYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ L ist❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street N Street Name City <br /> 445 W 4LL��r St <br /> 2. e � Uo �,tcot 5r�, � NOr)i01' � Unit <br /> 3. ,a �� <br /> 4• OqI45Unit 9 <br /> , <br /> s \ ' Unit 4 <br /> 7. 0 uc�,, W0 Wr <br /> U 5 <br /> 9. <br /> - Unit 6 <br /> 10. <br /> Specific Date Range of Informative Requested: From � `ialr">,CcQ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDER=1)TANK(UST)CLEANUP ITC(LOP) HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE V J� <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY WASTE TIRE `� / •. <br /> UNDERGROUND TANK(MONITORINaIRE OVAL)D( DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY,�- MOTEUHOTEL PUMPER TRUCK/YARD/CHEM TOILET$ <br /> TATTOo/BODY PIERCING OO1ISPA D USE APPLICATION SITES <br /> MEoIcAL wA$TE FAcaR VVZ OTHER(PLEASE SPECIFY) �� l cs <br /> WELL AND SEPTIC PERMrr RECORD5 ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-0:00PM - 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)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted—f r additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the ext business day. <br /> 2. The EHD will notify the appllca t tf 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 wooled 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 samecondition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same ppllcant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> a-0 I e co � f� 0 10 <br /> EHD 48-06 8/U4108 PUBLIC RECORDS RELEASE APP FORM <br />