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1 <br /> EHD LOG NUMBER <br /> )ATE RECEIVED SAN JOAQUIN COUNTY <br /> -a n <br /> ]ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.orglchd <br /> j493. <br /> E�KYI�,',O�Wi=NI' HFAMI PUBLIC RECORDS RELEASE APPLICATION <br /> t ,r ',i'7"MI--.. in. 1 BUSINESSfAGENCY: <br /> APPLICANT: r1 ""� <br /> ADDRESS: <br /> PHONE 0). 124 ( 6�'- - (O PRONE(2). ��n �-�> - {�0 FACSlM11_E:' <br /> L�1 <br /> TEAITATIVE'APPOINTMENT DATE: �1`"'Y�' T.: � <br /> (Pleaso allow 10 business days from date of application submittal-•Tentative only-must be cenflrmed) <br /> 0 CHECK BOX TO EXPEDITE REQUEST.$93100 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OFAPPLICAN7 �J'u'""�'`��' DATE 7,L <br /> [U� <br /> UNIT DISTRIBUTION M Unit i E3Unit 2 E) Unit e -I:4 ❑ Unit 5 b Unit 6 13 Other(electronicllistshriaps) <br /> FILE ADDRESS EHD USE ONLY <br /> R'4 �3 <br /> street Name y] r��,'� _ City <br /> LI o, <br /> cJ 1 4. <br /> 7. J _ ,�r�rw' uI S G <br /> 9. <br /> 10. 'il' <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> IM HOUSING ABATEMENT 10SOLID WASTE FACdLITYNEHICLE <br /> �I�DERGROUNO TANK(UST)CLEANUP SITE(LOP) []FOOD FACILITY C3�W'�m�� <br /> O OTTER CLEANUPSITE(NON-LOP) 0 FOG KENNEL DAIRY <br /> 0U)t[DERGROUNUTANK(AAS7NTTORINGIREMOVAL) G]CHICKEN RANCH ❑wASTEWAT£RTREATMENT PLANT. <br /> 0 HAZARDOUS WASTE GENERATOR ❑IdtOTEL1WOTEL Q PUmPERTRUCKNARDICHEMA TOILETS <br /> CI TIERED PERMITTED FACILITY ❑POOLfSPA 0.LAND USE APPLICATION SITES <br /> 0 TAT7001600Y PIERCING M OTHER(PLEASE SPECIFY) <br /> ❑MEDICAL WASTE FACILITY <br /> WELL AND SEPTIC PERWIT RECORDS ARE AVAILABLE FOR REVIEW• MONDAY-FF4DAY$:00 AM-S'OOPM - E= JMNG 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to 2091464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with#Ile addresses,contact <br /> the EHD.Applications received atter 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 <br /> approximately ten 110)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may,require a$93.Do deposit prior to review. <br /> END 4"2-Mg <br /> uta+os <br /> I <br /> Z-d 8996-L99 60Z uailV uBA m9-10 d49:V0 90 SZ 9ej <br />