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vnICRCIiCIVCV <br /> SAN JOAQUIN COUNTY u VV V V�I <br /> ENS _JNMENTAL HEALTH DEPARTP NT <br /> 304 East Weber Avenue, 3 Floor, Stockton, CA 93T02-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd� <br /> PUBLIC //✓✓�� <br /> UBLIC RECORDS RELEASE APPLICATION 7q 73 <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: �Z2Ae64 <br /> PHONE(1): M 3 Zo-q 4- PHONE(2): FACSIMILE: Sr <br /> TENTATIVE*APPOINTMENT DATE: OA-� >C /p Time: g30�F•— <br /> (Please allow 10 business da from date of application submittal-*tentative only-must be co it ) <br /> ❑ CHECK BOX TO EXPEDITE EQUE 5.110 FEE(CA OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATF. eeZ16 /0/- <br /> Electronic <br /> Electronic Information: ❑ List❑ Map-Description: 099h V111%d <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> k 2. j .P YP ❑ Unit 2 <br /> 3. <br /> oe <br /> 4. - - Unit 3 <br /> 5. <br /> 6 nit 4 <br /> 7. <br /> $ Unit 5 0 <br /> SS ' <br /> 9. ' <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: Fr m to ' <br /> �� ENVIRON NTAL HEALTH DEPARTMENT FILES N <br /> 91 N yNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> C=ERCLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> CERGROUND TANK(MONRORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> (� DOUS WASTE GENERATOR ❑CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARD/CHEM TOILETS <br /> TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑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 WIMM <br />