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DATE RECEIVED EMD LPG NUMBER <br /> SAN �IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> 1��Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www,sigov.org/ehd <br /> � tAePan, <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �'re BUSINESS/AGENCY: TfiiotlR r 6L�eo&ql1.N,�.. <br /> ADDRESS: OD J;,�r� I✓, P_ CMZ_. CITY/STATE/ZIP: , 7c3crar,7N.�->�b ICA�9S���� <br /> PHONE(1): 17j(�--M-411100 PHONE(2): T-6 T 77G7- FACSIMILE: �— <br /> TENTATIVE*APPOINTMENT DATE: /A/1 Time; S q M <br /> (Please allow 10 business days from data oTapollcation submittal-`T®nfadve only 7 must be confirmed) <br /> ❑ CHECK BOX TO PXPEDITE REQUEST-$125 FEE(C R_ G CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS(DAYS <br /> SIGNATURE OF APPLICANT T ,�_LOr DATE L/ <br /> Electronic information: Lj List❑ Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street-# Street Name City Unit 1 <br /> Z. r'4 `"t` �/ unit 2 <br /> 3. a ✓P_ 7�a c� a c P/ 1j <br /> l L �r5 l <br /> 4. V r J~?_ � L r(9rl f1 � ` �(�J � Unit 3 <br /> 5. U1 <br /> 6' / U•P 'Ge.s O Unit 4 <br /> ' n <br /> 8. •� atm c/ S'S' - Units <br /> 9. <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES rr <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE 7 /u <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY ASTE TIRE [3- <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) *,DOG KENNEL DAIRY 6 r I) <br /> HAZARDOUS WASTE GENERATOR iZ6 ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT (Z I <br /> ,TIERED PERMITTED FACILITY "Y�— ❑MOTELIHOTEL ❑PUMPER TRUCKIYAR4/CHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> © MEDICAL WASTE FACILITY XCOMPLAINT•RECORDS ❑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 ton 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(2091464.0138 or mall 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 now 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 some applicant may require a$125 deposit prior to review. <br /> LHD OU ONLY <br /> EHD 48.08 817M1 <br /> Z0/Z9 39Vd DNI -WiN3SO�1 �13QN38 V06VBL6916 SO:CT TTOZ/T0/ZT <br />