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DATE RECEIVED <br /> SAN JOAQUIN COUNTY • EHD we NunlseR <br /> I, ENVIRONMENTAL HEALTH DEPARTMENT <br /> — 600 East Main Street, Stockton, CA 95202-3029 <br /> JUt; .� 209 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.orgl4d4 <br /> .:_, H_ALIH PUBLIC RECORDS RELEASE APPLICATION <br /> {t7l':IGANT:v" an VP rj(,r,-)(70H BUSINESSIAGENCY: CCC I�YQ�r ST <br /> � <br /> ADDRESS: d L IF- SY(1� IUS CIl,r3tateRlP O C� -/ -5�ZC� <br /> PHONE(1): Ce't,) - �c�&_4 PHONE(2): <br /> A�, 11 II FACSIMILE; �$-GI-�- <br /> TENTATIVE"APPOINTMENTDATE; I`" 2__ 1 kVU j ��q ip <br /> (Please allow 10 bvslness days from date of appi(wtion submittal-'Tentative only immust be confirmed) <br /> ❑ CHECK BOX To EXPEDITE Q�U�ES $105 FEj �A,S�H OR CHECK ONL REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 1/�/�n /"I [eD/1 L7/(f 7 DATE <br /> Electronic Inf List ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# I� Street Name City 1 <br /> 1. 1,),21,),2!5- L HLI) -, (-., I G 7 S7 7 5 Unit1 <br /> 2. <br /> 3 C1 unit z /J <br /> 4. Unit 3 <br /> 5. .0000 <br /> B. <br /> Unit 4 <br /> 7. <br /> B• ❑ unit 5 <br /> 8. <br /> 10, ❑ unit$ <br /> Specific Date Range of Information Requested: From -1 (D ���� <br /> to _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES r,) jam,/• <br /> DERGROUND TALAR(UST)CLEANUP 51TE(LOP) ❑HOUSING ABATEMENT ❑ <br /> THEe CLEANUP SITE NON-LOP //yy SOLID WASTE FACILITYIVEMCLE <br /> 43 <br /> UNDERGROUND TANK(MONRGRINGIREMOVAL)Ck DOG SOLID <br /> WASTE TIRE ( I n i . <br /> ❑HAZARDOUS WASTE GENERATOR ❑DAIRY <br /> ❑TIERED PERMITrEO FACILITY ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> Q TATTDOIBODY PIERCING 0 MOTELIMOTEL ❑PUMPER TRUCKIYARD/CHEM TOILETS <br /> •MEDICAL WASTG FACILITY ❑ LISPA ❑LAND USE APPLICATION SIT <br /> OTHER(PLEASE SPECIFY) - V.'Tirmer�kniv�I>ut�I�nS <br /> WELL ANO SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FR DAY 8:00 AM-5. OPM - EXCLUDING HOLIDAYS, <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above b checkingthe appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2001464.0138 or mall to the add rose indicatd Indicated <br /> above. Address <br /> ranges will not be accepted-for additional assistance with file addresses, contact the EHD. ApPIICatlOns 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 fife 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-OS F04I06 <br /> PUBLIC RECORDS RELEASE APP FORM <br />