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..r <br /> EHD LOG NUMER <br /> DATE SAN .JOAQUIN COUNTY <br /> L "= ENVIRONMENTAL HEALTH DEPARTMENT <br /> r p I <br /> Z010 600 East Main St. Stockton, CA 95202-3029 <br /> j t � ehone: (209)468-3420 Fax: (209)464-0138 Web: wwwsjgov.Drglehd <br /> Rpr;li;SM'1C,': PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: KviSten Lt i BUSINESS/AGENCY: hw• ..�L. L, j� <br /> ADDRESS: 1411A WI& ..: Ave Sk4t C CITYISTATEIZIP; I eA RMI <br /> PHONE(1): o to PHONE(2): (Sw) ZZt-TKA* FACSIMILE: (4U.s 'Itiv -oboj <br /> TEN A IVE•APPOINTMENTDATE: Time: <br /> (Please allow 10 business days from date of appliaetion aubmW.I.-Tontadve only-most be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUES -$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT_ DATE 1(131,- <br /> Electronic Information: ❑List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street N street Name city ❑unit i <br /> ^, 1. Ito J t 0 <br /> UVL 2. t?,% Unit 2 n <br /> 3. t n 6r?r / Te <br /> 4. rjS nit 3 1 <br /> 5. ,.S U t i�t vii y - Trlh <br /> 6. •{o E nit <br /> 7. �. <br /> ❑unit s <br /> 0. ❑unit 6 <br /> Specific Date Range of Information Requested: From MAO to PWS/A4 �' f <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES o l//f-y��-,�,�/j <br /> •� UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE 0 <br /> ®DINER CLEANUP SITE�(N ❑ <br /> ON-LOP) Fool)FACILITY ❑WASTE TIRE <br /> (M <br /> ®UNDERGROUND TANK ONITORINGIREMOVAL)� ❑DOG KENNEL ❑DAIRY <br /> ®HAIARDOUs WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRucKIYARDICHEMN:AL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ®OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMrT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 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 he 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 atter <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD flies exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be hold 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 END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> END use ONLY <br /> _ (A <br /> _ r <br /> T Z <br /> END 48-06 ll: ?!Y tnNZ OMdVA&ZA&AftliW1rc G %%Jan a o- L 4. L e7M11D <br /> A*vvic, VW�A"f1 .A% i+ wap-4;Wl LISTs[A% i, 4 6k4AV ued O& -1iest4Yl•v,AwMar f•Nr+ • <br /> 100/L001A •1 HVj L9:L0 OLOZ/EL/SO <br />