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r Jar;26 12 01:02p � � p.2 <br /> l <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 qq <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www_sjgcv.org/ehd <br /> 0 <br /> 'l. <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APP ##\;- C co BUSINESS/AGENCY: 4g o/� C��✓ ""'y�T <br /> ADDRESS: �(O 1V. raj �Sf, CITYISTATE/ZIP: Lo✓,f C✓¢ �J Z Y�j <br /> PHONE(1): 701? S f✓7—70 n— PHONE(2): 707� ��62- ffOSS FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please avow 10 business days from date of applicatto submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUE T 12 FE H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City _ ❑Unit i <br /> !J ;'S;� �srvv�� d- <br /> 2. /L�^(�tG(� Vi�( �{1S J�(! Sf fN El Unit 2 <br /> 3. <br /> 4. ❑Unit 3 <br /> 5. f �� <br /> g, ❑Unit 4 <br /> 7. <br /> g, ❑Unit 5 <br /> 10. Un' <br /> Specific Date Range of Information Requested: From j Q(p to U✓'P e"L e <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILrrYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> ❑UNDERGROUND TANK(MONIfORINGMEMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEIJHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑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$125 deposit prior to review. <br /> [''.D USE Otd'_Y <br /> EHD 48.06 8/1 f11 <br />