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DATE RECEIVED EHD LOG NUMBER <br /> , ����/;fL (�' SAN JOAQUIN COUNTY <br /> If <br /> REC� V LL' ENVik�t NMENTAL HEALTH DEPARTIVIT, T <br /> 200 304 East Weber Avenuc,_3ra_'loor,Stockton, CA 95202-2708 � <br /> 00 -2 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> EwAROWEN1 HM PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: L BUSINESSIAGENNCY: <br /> ADDRESS: O P15— A"C V"A (t vVT-� C AL <br /> PHONE(1): -0 0-21 PHONE(2): 201 FACSIMILE: <br /> T NTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from dale of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE U ST-$ 5.0 EE CASH 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 1 <br /> 1. d 1.4 I A tAP 7 S@ VA I TE <br /> 2. M ftegrE 4ki1= 3 7 <br /> ❑ Unit 2 <br /> 3. <br /> 4 Unit 3 <br /> 5. <br /> Unit 4 <br /> 6. :a <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tUNDERGROUND TANK(UST)CLEANUPSITE(LOP) 11 HOUSING ABATEMENT 11SOLID WASTE FACILITYNEHICLEHER CLEANUP$ITE(NON-LOP) 13 FOOD FACILITY E3 WASTE TIREDERGROUND TANK(MONITORING/REMOVAL) 11DOG KENNEL O DAIRY <br /> ZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY El MOTELIHOTEL 13 PUMPER TRUCKIYARDICHEM TOILETS <br /> 13 TATTOO/BODY PIERCING 13 POOLISPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 13 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD4946 9/13/2006 <br />