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tHU LUG NUMtitK <br />ERECEIVED SAN JOAQUIN COUNTY <br />� ENVIRONMENTAL HEALTH DEPARTMENT " <br />600 East Main St. Stockton, CA 95202-30� <br />Telerhone: (209) 468-3420 Fax: (209) 464-0138 Web: rg/ehdU <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: 1t_z <br />1 t >✓ BUSINESSIAGENCY: f= C-kj 9 2-(v Z (o <br />ADDRESS: �IJ Q, • c Yrc 2 C) O CITY/STATEOP: <br />PHONE (i): �j - �0 3 PHONE (2): �I0-�o�5'(P2%� FACSIMILE:5I0-2cl5 - 2�5(, <br />TENTATIVE" APPOINTMENT DATE: . Zo) O Time: S /� <br />(Please allow 10 business days from date of applicatlo submi *Te tative only - must be confirmed) <br />SACHECK BOX TO EXPEDIT QUE - $115 F H OR CHECK ONLY) -REQUEST PROCESSED IN 3 BU INESS AYS <br />TURE OF APPLICA DATE <br />FcripElectronic Information: List t n: <br />FILE ADDRESS <br />to a END USE ONLY <br />Unit 1 <br />{ unit2 <br />OEs, cD <br />Unita <br />�. <br />Street # <br />Z3C) <br />Street Name <br />C'_ <br />City <br />IE)o <br />2. <br />3- <br />2)g <br />Z <br />, C) �d_ <br />% S�zYi <br />4. <br />f� C� V� i <br />` `;. <br />5. <br />3 <br />, S �-C> Av <br />. ,; <br />� T Z b ; leo WA <br />ti;unit 41, <br />s. <br />W . a , n S <br />_2 <br />Unit 5 <br />8- <br />22--7C)O <br />9 qJD <br />9- <br />S7f <br />(10 / 1 Unit 6 <br />11 <br />2— <br />t <br />I <br />Specific Date Range of Information Requested: From Q r to ►-Y'Z'se n �`, <br />ENVIRONMENTAL REAI TH DEPARTMENT FILES --� <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT 12SOLID WASTE FACILITYNEHICLE <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br />UNDERGROUND TANK (MONITORING/REMOVAL) Qi- ❑ DOG KENNEL ❑ DAIRY <br />HAZARDOUS WASTE GENERATOR CHICKEN RANCH IRWASTEWATER TREATMENT PLANT IrJ � <br />TIERED PERMITTED FACILITY (71- ❑ MOTEL/HOTEL LFPUMPER TRUCK/YARDICHEMICAL TOILET <br />///❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND 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. 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 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. 0� <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 />n1 1 / E ONLY ti1,� ^ • W��• <br />9142 cAr,,A�/'1 - �lA� ri I•o n., i- -LAM A 7 171 n i In i f _ , I 1 1 -Lfl <br />�� r;,�� ► i Off?� ra , •� i ,�, .f.�:, <br />1 <br />