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I l /'L5/'LUO U 13:5 ( I -AA 1d001/001 <br />DATE RECEIVED 0 <br />EHD LOG NUMBER <br />SAN JOAQUIN COUNTY 46 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 .1007> <br />Telephone: (209) 468-3420 Fax: (209)464-0138 Wets: www.sjgov.Org/e 3d <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: BUSINESS/AGENCY: <br />ADDRESS: Clty/Statelzip42 <br />PHONE (1): —(-9L0 `'f "QPHONE (2): FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: Time: I 14M <br />(Please allow 10 business days from date of application Submittal - "%ntative only - must be confirmed) <br />® CHECK BOX TO EXPEDITE RE T -; 3 FEE (CASH Olt CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS AYs <br />SIGNATURE OF APPLICANT DATE �}8 <br />Electronic Information: <br />A <br />❑ List [] Map — Description: <br />FILE ADDRESS <br />StmeYName <br /># WM.0 <br />Specific Date Range of Information Requested: From <br />►WE;r---- <br />1 TH_ <br />to <br />Unit 6 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES �0 <br />IUNDERGROUND TANK (UST) CLEANUP SITE (LOP) HOUSING A6ATEMENT SOLED WASTE FACILITY/VEHICLE ' <br />OTHER CLEANUP SITE (NON -LOP) FOOD FACILITY WASTE TIRE <br />1.4.f <br />UNDERGROUND TANK (MONITORIN131REMOVAL) 0( DOG KENNEL DAIRY <br />HAZAROWS WASTE tiENERATORVCHICKEN RANCH WAsTewATER TREATMENT PLANT <br />TIERED PERMITTED FACILITYd- MOTELIHOT>_l PUMPER TRUCK/YARD/CHEM ToiLETS <br />TATi'oo1BODY PIERCING OOOSPA O USE APPLICATION SITES <br />MEDICAL WASTE FACILn(Y- OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT REcORm ARE AVAILMLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-S:OOPM - EXCLUDING HOLIDAYS. <br />9. List up to ten addresses in the space above. Select the type(s) of flies 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 mai( 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 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 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 $109 deposit prior to review. <br />EHD USE ONLY <br />LIZ <br />cnu 40 -VO auwuo PUBLIC RECORDS RELEASE APP FORM <br />MEMIM <br />A <br />❑ List [] Map — Description: <br />FILE ADDRESS <br />StmeYName <br /># WM.0 <br />Specific Date Range of Information Requested: From <br />►WE;r---- <br />1 TH_ <br />to <br />Unit 6 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES �0 <br />IUNDERGROUND TANK (UST) CLEANUP SITE (LOP) HOUSING A6ATEMENT SOLED WASTE FACILITY/VEHICLE ' <br />OTHER CLEANUP SITE (NON -LOP) FOOD FACILITY WASTE TIRE <br />1.4.f <br />UNDERGROUND TANK (MONITORIN131REMOVAL) 0( DOG KENNEL DAIRY <br />HAZAROWS WASTE tiENERATORVCHICKEN RANCH WAsTewATER TREATMENT PLANT <br />TIERED PERMITTED FACILITYd- MOTELIHOT>_l PUMPER TRUCK/YARD/CHEM ToiLETS <br />TATi'oo1BODY PIERCING OOOSPA O USE APPLICATION SITES <br />MEDICAL WASTE FACILn(Y- OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT REcORm ARE AVAILMLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-S:OOPM - EXCLUDING HOLIDAYS. <br />9. List up to ten addresses in the space above. Select the type(s) of flies 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 mai( 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 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 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 $109 deposit prior to review. <br />EHD USE ONLY <br />LIZ <br />cnu 40 -VO auwuo PUBLIC RECORDS RELEASE APP FORM <br />