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a <br />DATE RECEIVED <br />SAN JOAQUIN COUNTY EMD LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjg h <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT. �IC��RIQ N [-/- BUSINESS/AGENCY: ell & U <br />ADDRESS: 0 1�11,Il/l1a � city/State/Zip <br />PHONE (1): 'ZCA- - UQ <br />PHONE (2): Z04 - 'L 1 -Z 6 b S 1=AC51MILE: <br />TENTATIVE* APPOINTMENT DATE: (Z - 0-033 O <br />(Pleas® aIIGw 10 buslnaSS days from date a plication Submittal - "rantati on be confirmed) <br />Q CHECK BOX TO EXPEDITE REQU0b'r�$t0S F C H OR-&ECK ONLY) - REQU <br />SIGNATURE OF APPLICANT <br />Electronic Information: ❑List ❑ Map i3escrlpfiion: <br />EST PROCESSED IN 3 BUSINESS DAYS <br />DATE <br />Specific Date Range of Information Requested: From 1 to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />AUNDEROROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY/VEHICLE <br />OTHER CLEANUP .SITE (NON -LOP) 17 FOOD FACILITY t7 WASTE TIRE <br />i4 UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL d DAIRY <br />,0 -HAZARDOUS WASTE GENERATORtK Cl CHICKEN RANCH tO WASTEWATER TREATMENT PLANT <br />TIERED PERMITYED FACILITY 0 MOTEL/HOYEL © PUMPER TRUCK/YARDICHEM TOILETS <br />LI TATTOO/BODY PIERCING tO POOUSPA ❑ LANO USE APPLICATION SITES <br />MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE: AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM,S;QOPM - EXCLUDING HOLIDAYS. <br />I. List up to ton 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 mats 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 1=HD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ton (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 $105 deposit prior to review. <br />=LJF% 11�ASu \i <br />T9 3Ddd NOdIaOMN3 96LT66960Z TV:TT 890Z/LT/ZT <br />