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. �✓ SAN JOAQUIN COUNTY tnu LUU NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 on I y <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: �� T,/1 V, r-e�, m gni �..1---n BUSINESS/AGENCY: <br />ADDRESS: "S �-G- C iw-� CITY d e.- 10 ..YN0 <br />STATE C <br />PHONE (1): S-1 0 6 9 -EF ^ 6 PHONE (2): FACSIMILE: !�_)D <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 ES�T - $93.00 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE 't f4 I 09 <br />Electronic p List ❑ Map - Description <br />Information <br />FILE ADDRESS EHD USE ONLY <br />Street # Street Name City <br />1. r\j- `",b n:- s �, c1z El Unit 1 <br />2. t S`- j _ h w.l-dr » I <br />3. C' 10 SA o r-�-h r <br />4. 1:1Unit 2 <br />6. U6. <br />11it <br />7• Unit 4 <br />s. <br />9. ❑ Unit 5 <br />10. - ❑ Unit 6 <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILESRGROUND <br />TANK (UST) CLEANUP SITE (LOP) <br />;*WCEER <br />0 HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITYIVEHICLE <br />CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />13 WASTE TIRE <br />UrUNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ DOG KENNEL <br />❑ DAIRY <br />1311AZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT <br />0 TIERED PERMITTED FACILITY <br />13 TATTOO/BODY PIERCING <br />❑ MOTELIHOTEL <br />❑ PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />® MEDICAL WASTE FACILITY <br />0 POOLISPA <br />13 OTHER (PLEASE SPECIFY) <br />❑ LAND USE APPLICATION SITES <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:00PM - FXCI_unwr. Hem mevs <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 (209) 464-0138 or mail to the address <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 EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <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 END 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 $93.00 deaosit prior to review_ <br />10131!2006 <br />