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DATE RECEIVED <br /> SAN.JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENX'AL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202 <br /> Telephone: (209)46$_3420 Fax: (209)464-0138 V4'ef�: <br /> r- _ .. b or D <br /> PUBLIC RECORDS RELEASE APPLI IO\ <br /> APPLICANT: FV IJ� 1�1 BUSINESS/AGENCY- <br /> ADDRESS: 121 (✓ r <br /> PHO Al �S4 ! C I . PHONE �/-/(fie) 712 _2,�1��FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE:�)e — I AYTime: <br /> E <br /> (please allow 10 business days from date of application submittal-*Tentative only'must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$95.00 TEE(CASH OR CHECK ONLY)-REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ' <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# _ Street Name — - <br /> )� �v a City (AS U( - 6 r Unit t <br /> 1?2g —�, S acl� <br /> 2. - <br /> � ❑ Unit 2 <br /> 4. _ VUnit <br /> 6. <br /> 7. <br /> 8. - ❑ Unit 5 <br /> 9. <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> euNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT d SOLID WASTE FACILITYNEHICLE <br /> Cl 9THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑ WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) Q DOG KENNEL CJ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR C CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> C]TIERED PERMITTED FACILITY U MOTWHOTEL Q PUMPER TRUCK/YARD/CHEM TOILET5 <br /> 0 TATTOO/BODY PIERCING E3 POOL/SPA ❑ LAND U5E APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM•S:OOPM - 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 EMD 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 /> eHDas-a6 srierzoor <br /> TO 35)Vc1 NNS XVI �1d1S N73Q-109 6Z8L99880tU 80 :9T LOOZ/ZO/80 <br />