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t, J, �.. u ...v 1.L•YJ rni Lg 001/U01 <br /> 'UE SAN JOAQUIN COUNTY END LOG NUMBER <br /> ENVIRONMENTAL, HEALTH DEPARTMENT 0007 <br /> APP, Za J$ 304 Cats( Weber Avenue; 3"i Floor. Stockton,CA 95202-2708 <br /> Lir �� j�i TI I Telephone <br /> 468-3420 fax: (209)4G4-0138 Web: �vmw.sjgov.org/ch <br /> ' icrR5,'1 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1f SUSINESSIAGENCY: S"ift <br /> . r <br /> ADDRESS: JV,?f�i i ) i>:_ ; -L y y n / Z / <br /> —�—..L..�.9��-.aEZ�Jif .�Vl..,_,...�� �'^�X..r'S�.._ !� <br /> PHONE(1):���✓'4t " GUS) PHONE(2): I FACSIMILE: G Vii`PI1 .,.,LV60&' <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 RE UEST-$93. 0 F E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION C7 Unit 1 ❑Unit 2 ❑Unit 3 ❑Unit4 1:7 Unit 5 M Unit 6 ❑ Other(electronic/lis maps) <br /> FILE ADDRESSFEHD USE ONLY <br /> Street# Street Name City <br /> 1. ltiCX3 - - —..-- <br /> 2. <br /> - -- ------_......6. <br /> -..... <br /> 3. <br /> 4. <br /> n <br /> 7. — - <br /> 8. jr <br /> ` <br /> 9. - - <br /> 10. � <br /> Specific Date Range of Information Requested:From I to <br /> �• <br /> ENVIRONMENTAL HEALTH DEP �RTMENT FILES <br /> *bNDERGROUND TANK(LIST)CLEANUP SITE(1.013) ❑HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEHIGLE <br /> OTHER CLEANUP SITE(NON-LOP) 1:1 FOOD FACILITY ❑WASTE TIRE <br /> 'J LUNDERGROUNDTANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH bLWASTEVVATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPERTRUCK/YARDICHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA _ LAND UsE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY,-FRIDAY 8:40 AM-5:00M - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)lof files from the list above by checking the w <br /> appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the address tt <br /> indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant if any EHD files exist. An appointment for review will be confirmed l <br /> approximately ten(10)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 mmediately 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 si <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> END 48.02.006 - <br /> 1114105 <br />