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4'r -l" <br />Ike <br />EHD LOG NUMBER <br />� 4• °1� !I' SAN JOAQUIN COUNTY • � <br />ENVIRONMENTAL HEALTH DEPART �N „ <br />600 East Main St. Stockton, CA 9520 029 <br />T jephone: (209) 46B-3420 Fax: (209) 464-01381 �vrvJw sjgov.orglehd <br />Chir• r <br />ED'.Y`ES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />N <br />ADDRESS: 16, n --t. 1 J1 <br />PHONE(1): 390I PHONE (2):SI <br />TENTATIVE* APPOINTMENTDATE: Fr <br />(Please allow 10 business days from date of appTc <br />INESS1AGENCY: C <br />CITYISTATEIZIP: CoSkti <br />FACSIMILE: '510–Z-9'5- <br />Z 2 b U Time: A -M <br />I - Ti ave only - must be confirmed) <br />HECK BOX TO EXPEDITE REDT - $115 SH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUST ESS D YS <br />SIGNATURE OF APPLICA <br />DATE <br />Electronic Information: 4 ListXMap — scription:i /D ✓v' D \,Ai r'� c UDf <br />FILE ADDRESSt/` <br />li EH USE ONLY <br />El U.. it 1 <br />Street t! <br />Street Name City <br />1. <br />20 I <br />S -t hS��' • vJ = <br />U`I oz No co <br />1 0&si Unit 2 <br />2. <br />7- <br />Lo U.J S �`-v. <br />3. <br />it 3 <br />OZ '/ o 6Q %// � Unit <br />kyr Icot <br />'j"W A GJ (.0 ��� OUnit 5 <br />2 <br />5. <br />333I` <br />6. <br />7. <br />zZ3 <br />16D I <br />11'' '�t� <br />W � V r ��✓l <br />i`j— n - <br />8. <br />IO2-2, <br />t-= , PY-0 <br />9.23 <br />S1DCtoSfi. <br />uyT pESi D o�9 <br />Unit 6 <br />10. <br />Sped is Date Range of Information Requested: From P a V I i L -�r to6Z- <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACIUTYIVEHK:LE - 7 <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY WASTE TIRE <br />5TUNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />AZARDOUS WASTE GENERATOR El CHICKEN RANCH ,WASTEWATER TREATMENT PI <br />IERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKNARDICHEMICAL TOILETS <br />-1 TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />1 MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />Y� <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />01- 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) 4640138 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 $115 deposit prior to review. <br />5. If you need further assistance, please contact Diane Martinez, at (209) 468-3425. <br />EHD USE ONLY <br />EM I �; 29Z• 0: d n,) 9, -0U, coni Ups/v x>IkT(K!%r '-' <br />ME FIN I ME I <br />EM I �; 29Z• 0: d n,) 9, -0U, coni Ups/v x>IkT(K!%r '-' <br />