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SAN J OAQUIN COUNTY - <br /> ENVII, VMENTAL HEALTH DEPARTMi <br /> 600 East Main Street, Stockton, CA 95202 <br /> Telephone: (209)468-3420 Fax: (209)464-0'1138 Web: www.sjgoV / <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: D CSI %.^ 'W-tv' <br /> BUSINESS/AGENCY: <br /> ADDRESS: 3V b 1`l• Crory+ Vn t, lakVd, C l�vl�clL u g S3!e Z <br /> PHONE(1): Zn't 166f - O'PJT i PHONE(2): - Z,-I-5Z <br /> FACSIMILE; ?%4 Cato-t " (016 15 <br /> TENTATIVE*APPOINTMENT DATE: f3 V Time:_ jNq p(s _ <br /> (Please allow 10 business days from date of application subm�ttal -"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST <br /> `-�$95.�00�FEE(CASH OR CHECK.ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT D --V--,li-' DATE }IZS.I�7 <br /> Electronic Information: ❑ List ❑ Map-Description <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> ❑ Unit 1 <br /> 2. <br /> 4�nDJ1,Q, S�ctL�oJ; Q � EDUnit2 <br /> 3. <br /> Alm- <br /> 4. Unit 3 <br /> 5. <br /> 7. U,F� ] <br /> 8. ❑ Unit 5 <br /> 9. <br /> 10. ❑ Unit 6 <br /> i <br /> Specific Date Range of Information Requested: From _ Z0LQy I to C'3 q Irk <br /> ENVIRONMENTAL HEALTH DEPAIRTMENT FILES <br /> JAI UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> .11 THER CLEANUP SITE(NON-LOP) I El FOOD FACILITY 0 WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) Q DOG KENNEL 13 DAIRY <br /> d HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS 9 <br /> 11 TATTOWBODY PIERCING 11 POOL/SPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 171 OTHER(PLEASES PECIFY), <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAYFRIDAY 8:00 AM-5:00Pryi - 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. V <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,4111 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 <br /> submitted when the file is avalla4le. may not be immediately available for review. A now application may be <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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48.06 511612007 <br />