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ATE RECEIVED EHD LOG NUMBER <br />E/'+EV�\ !E® SAN .IOAQUIN COUNTY f <br />V ENVIMONMENTAL HEALTH DEPARTMER c . <br />N/)2 6Wl z 600 East Main St. Stockton, CA 95202-3029 <br />g-6�61 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENVIRONMENTAL HEALTH <br />PERMITISERVICES <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: ALo6! j BUSINESS/AGENCY: Liv_2 O J,— <br />ADDRESS: 40 � I,J . ocvtc- �4 • CITYISTATE/ZIP: U&k:` Gft <br />PHONE (1): 310 -03 i i PHONE (2); FACSIMILE: '30- 03-?'l- <br />TEAfTATIVE'APPOINTMENT DATE: q -10 - 1'L Time: I o= (YD <br />(Please allow 10 business days from date of application submittal - •Te Wrye oobl -must be confirmed) <br />❑ CHECK BOX TO EXPEDITE R25'(C <br />FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />EQU T - $1FE <br />SIGNATURE OF APPLICANT /mac DATE <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ Unn 1 <br />Street # <br />Street Name <br />city <br />1, <br />lk'3'40 <br />W, r_-, K+ Vk Lt.. <br />S-Ferktar <br />NOIcni ' kny <br />ILoca ❑unitz <br />2. <br />3359 <br />N.;f+C <br />g,unit3 <br />5. <br />un t 4 <br />g, <br />7, <br />❑ units <br />g- <br />Q Unit B <br />rio <br />Specific Date Range of Information Requested: From A.t.IC . n t _ ^ ^^ to <br />[EVNDERGROUND TANK (UST) CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT © SOLID WASTE FACIUCTYIVEHIC `/, ,,� 7 <br />® OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE � ! ' W G'- INS / <br />UNDERGROUND TANK (MONfTORINOIREMOYAL)'�'— ❑ DOG KENNEL ❑ DAIRY F� 3,0— I Z <br />® HAZARDOUS WASTE GENERATOR DT ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACfUTY1— ❑ MOTELMOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />TATTOoBODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY COMPLAINT RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REvlew: 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 209) 4"-0138 or mall to the address In Icated 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 it any EHD files exist. An appointment for review will be corltkmed approximately ten (10) <br />days after receipt of application. The tiles will be hold fora 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 he reorganized by EHD staff at the expense of the applicant. <br />Future me revieum by tbn xame applicant may require a $125 deposit prior to review. <br />• ENO USE ONLY <br />LO <br />Received Time Au 28. 012_ 2; 27PM_N'O 1014 <br />END M46 <br />