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r1 SAN JOAQUIN COUNTY EHD LOG NUMBER <br />Er', V ,< ONMENTAL HEALTH DEPARTII I�T <br />Est. 1 2007 600 East Main Street, Stockton, CA 95202-2708 <br />CJelephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />HLEA <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />S U K H J i <br />f S -• <br />JA S- L,-),-4 L_ <br />BUSINESSIAGENCY: ` <br />ADDRESS: <br />C3 LA L,4� <br />O /%K <br />S Te: C_/C '-7� <br />PHONE (1): ofV <br />J — 3'� <br />— SI �% <br />PHONE (2): <br />FACSIMILE: <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 REQUEST - $98.00 FEE (CASH OR CHECK LY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT �S ` * S ��� c� DATE—) V ' <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Street # <br />Street Name <br />City) <br />ETo -rE n_S <br />"r ~n (} 0 Unit 1 <br />e ❑ Unit 2 <br />(.?!nit 3 <br />Unit 4 <br />❑ Unit 5� <br />❑ Unit 6 <br />2. <br />3. <br />4 <br />5. <br />6 <br />7. <br />8. <br />9. <br />10. <br />Q (4 ® <br />%I'1 ki f/V / E7 T <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />0 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITYIVEHICLE <br />PV OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br />UNDERGROUND TANK (MONITORING/REMOVAL) 173 DOG KENNEL 13 DAIRY <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL 13 PUMPER TRUCK/YARD/CHEM TOILETS <br />13 TATTOO/BODY PIERCING E3 POOL/SPA 13 LAND USE APPLICATION SITES <br />0 MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br />1. 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 />3:00 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 $98.00 deposit prior to review. <br />EHD USE ONLY <br />*** If you should need further assistance please contact Diane Martinez @ (209)168-3425 directly. Thank You***. <br />EHD 48.06 9/14/2006 <br />