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SAN JOA(1UIN COUNTY EHD LOG NUMBER <br /> 111 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ANN 14 600 East Main St. Stockton, CA 95202-3029 ry <br /> j00hone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ntMTISEP�cEs PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 44-leN Q�ti, BUSINESS/AGENCY: &eeW,, se nit („L• <br /> ADDRESS: 3K34 WULY'S” 'j'* 'lie' C CITY/STATE/ZIP: Sa&YA�e,.& r.F1 =7t <br /> PHONE(1): a - 17236 PHONE(2): FACSIMILE: &4 -(So-OW-5 <br /> TENTH IVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of applkatlon submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST A122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT A ,c...- k-\ DATE ( 70 <br /> Electronic Information: ❑List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street s Sheet Name City <br /> i. . <br /> 2. S. treat} _ _ ala nh2 <br /> 3• sso3 S. Ac N 1 c015 — I <br /> D� • S�Is <br /> - nN a <br /> 5. 1o2So No X0/5 <br /> Unit <br /> 7. <br /> L3 unit a <br /> s. <br /> nit 8 <br /> Spacific Data Ranga of Information Raquasted: From <gfkJ to <br /> ,--�(/ ENVIRONMENTAL HEALTH DEPARTMENT FILE8 (� D <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ��� ����LLLL10 WASTE FACILI YNEHICLE `� f r <br /> HER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY STE TIRE <br /> [ ERGROUNOTANK(MONRORINCJREMOVAL)� ❑DOG KENNEL 3 <br /> ARDOUS WASTE GENERATOR DC ❑CHICKEN RANCH STEWATER TREATMENT PLANT �)_Z0 <br /> TIEREn PERMtirED FACILITY Q� ,❑I MynTELMOTEL LIMPER TRUCK/YARDICHEMICAL TOILETS <br /> I❑�,T�A�TTOOMODY PIERCING ktPOOL/SPA FRY <br /> 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. SOlact the type(S)of files from the gat above by checking the appropriate <br /> box(es). At least one file type MUST be selected, Fax to 1209)4840138 or mail to the address Indicated aboYe 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 END 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 name condmon as released will be reorganized by END staff at the expense Of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> END WE ONLY <br /> _I ,- D <br /> I <br /> r D <br /> rt <br /> EN 1 �0""2Z6O (regatd+�4' IDS Y (.i � � r Y etO&�E <br /> 100/100In XVd BCAL lLo7./bL/90 <br />