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Oct 01 08 02:10p Geologica 41' Y7-7880 p.1 <br /> Q ; � EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 1 <br /> U <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main 1 <br /> � 20Q a n Street, Stockton, CA 85202-3029 <br /> �elephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> 1F�f�iV1I4r` <br /> HEAL <br /> T}' PUBLIC RECORDS RELEASE APPLICATION <br /> � <br /> APPLICANT: BUSINESSIAGENCY: 6r'0 a <br /> ADDRESS: / L ry r ;' rPt Cilyfstatefzip -5�(.l <br /> PHONE(1): �f I �` �y7 E�P z- PHONE(2): FACSIMILE: YI_�` ��! '�0-ff0 <br /> TENTATIVE;APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST11 F ASH OR CHECI fPNLY)-REQUEST PROCESSED IN 3 BU NE S DAYS <br /> SIGNATURE OF APPLICANT DATE 6 r 6 <br /> / --1 <br /> Electronic Information: ❑ List n Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Streetft Street Name City <br /> 1 � Unit <br /> 2. fi ff e Al. Y.F, © Unit <br /> 3. C9 v� Cry a..a L . <br /> 4 Unit 3 <br /> 5. <br /> UnitA <br /> $- 3 o r A(/x•Gtn E tic d � C� r <br /> 7. b ❑ Unita <br /> 9 <br /> unit's <br /> 1U. <br /> Specific Date Range of information Requested:From r to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FAa1 rTYfVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 0 WASTE TIRE <br /> UNDERGROUND TANK(MotirroRINGIREMOVAL) ❑ DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> QTIERED PER.MiTTEDFACILITY M MOTELIHOTEL ❑PUMPERTRUCIUYARDICHEMTOILETS <br /> 1--rTATTOOIBODY PIERCING ❑POOLISPA ❑LAND SEA PLICATTOH SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) roc C. <br /> WELL AND SEPTIC PER%Arr RECORDS ARE AVAILABLE FOR REVIEW- MONBAY-FR[OAY$:0O AM-5:40PM - EKCLUDWG 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 EMD 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 fife 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$105 deposit prior to review. <br /> - - -- — --- — -E-HD-USE-ONLY-- -- <br /> I <br /> EHD 48-06 8104109 PUB LIG RECORDS RELEASE APP FORM <br />