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SAN JOAQUIN I.UUNIY <br /> ENI�r `�ONMENTAL HEALTH DEPART V <br /> Lei I11 bar East Main St. Stockton, CA 9524 <br /> 17pi}�/hone: {209) 46$-3420 Fax: (209) 4644138 VV uiri�w.sjgov.org/ehd <br /> �IF . ; p11 i iL-1-•. 1 <br /> PUBLIC RECORDS RELEASE APPLICATION_ <br /> APPLICANT: i Ili l ' ` •���- BUSINESSIAGENCY: t� <br /> ADDRESS: S h S+e 2CO CITYISTATEIZIP: LCOS �. - <br /> PHONE('i): t� -• (4 - �. PHONE(2): 10-���-{a�-(p FACSIMILE: 51.��'Zq <br /> TENTATIVE"APPOINTMENT DATE: f--y- 0 2- :Z b ( Time: <br /> (Please allow 10 business days from date of application sub I- Tentative only-must be confirmed) <br /> HECK BOX TO EXPEDITE REQ T-$115 SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSS ESS DAYS <br /> DAA <br /> SIGNATURE OF API'LlCA <br /> Electronic Information: Llst Map- scription: fb <br /> FILE ADDRESS (4 EHD USE ONL <br /> street# Street Name City Unit 1 <br /> cam+ . C .z <br /> 2. l.J`J F5 rq Try _ unit 2 <br /> 3. <br /> Unit 3 <br /> a. CA I I <br /> 8. 11�r-` ,�„� 5 Unit 4 <br /> 7. <br /> 8. ) 02-2, ��a n e d ' ` ❑Unit 5 <br /> 9. <br /> 1 a. unit s <br /> Specific Date Range of Information Requested: Fror to 1' ” <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACluTYNEwcLE <br /> i� OTHER CLEANUP SITE(NON-LOP) .: ❑FOOD FACILITY WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> EOUZARDOUS WASTE GENERATOR ❑CHiCKEN.RANCH BRWASTEWAT'ER TREATMENT PLANT <br /> IEREO PERMITTED FACILITY ❑MOT ELIHOTEL ❑PUMPER TRUCKIYARDIGHEMICAL TOILETS <br /> I ❑TATTOOIBODY PIERCING ❑POOUSPA ❑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 ANI-5:OOPM(EXCLUDING HOLIDAYS) <br />' 4. 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 /> 3:010 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 /> II 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 /> F 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> t 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 /> 4 END USE ONLY <br /> EHD 45-08 e127108 <br />