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DATE RECEIVE=D <br /> SAN JOAQUIN COUNTY EHD LOCA NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www•sjg 40 �Z T <br /> PUBLIC RECORDS RELEASE APPLICATION nn <br /> APPLICANT: RIC0421a GdN bL•h0 BUSINESS/AGENCY: eN U6U <br /> ADDRESS: S�d (t), w��Ma Clty/State/Zip l;p- gS <br /> PHONE(1); QG4-Xq 6 - 6 a� PHONE(2): Z04 3 2( 2 6 b S FACSIMILE: Q� <br /> TENTATIVE*APPOINTMENT DATE: (Z' d" 0 �; O <br /> (Please allow 10 buslnasS days from data a plication submittal-"Tsntadve only-,—Time: <br /> -must 6o confirmed) <br /> C7 CHECK 13OX TO EXPEDITE REQU $105 F C HO ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z- 1 <br /> Electronic Information: C] List❑Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1 f 9 ❑ Unit 1 <br /> T U u h �. YC• 1 D IN - 1FJ Ci.' �Y <br /> 2. <br /> ❑ Unit 2 <br /> 3. E o <br /> Ago <br /> 4. Z D s�nCLttUn 0c S,,vJ uYh !.I^� Units <br /> 6. _5 LC 1061AUg Ni ,oES,Nacp(yQ - Unit Y <br /> 7. <br /> s. <br /> 33'x- � ��+ � oz) ° 'E 3' /Ja 4;1�j�� ❑ unit 5 <br /> / ) ❑ unit 6 <br /> 10. Z�Q � C(L(.STrPa � Alr�. <br /> Specific Date Range of Information Requested:From a"'e ljk 1 <br /> to j9rC_itAk <br /> ��// ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> /�+-UNDEROROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑ t\ / <br /> OTHER CLEANUP SITE NON-LOP ❑ SOLID WASTE FACILITY/VEHICLE <br /> ( ) FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAO)y CI DOG KENNEL ❑DAIRY n \Z <br /> `HAZARDOUS WASTE GENERATORtX ❑CHICKEN RANCH ❑ r� <br /> C3 TIERED PERMITYED FACILITY WASTEWATER TREATMENT PLANT <br /> ❑MAOTEUHOTEL M PUMPER TRUCK/YARD/CHEM TOILETS <br /> C7 TATToo/BODY PIERCING ❑POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONOAY-FRIDAY 8:00 AM-5:ooPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ton addresses In the space above. Select the type(s)of files from the fist above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464»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 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> #3 N A <br /> LuLtL 5 crit 1 1 <br /> + <br /> . Y� <br /> EHD 4e-06 8/04108 PUBLIC RECORDS RELEASE APP FORM <br /> TO 3DVd N0dIa039N3 56LT6656aZ Tb :TT seeZ/LT/ZT <br />