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= �RIEREFEIVEp-� � • <br /> L II 1 SAN JOAQUIN COUNTY EHD Loc NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> a 600 ED$(Main St. Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web: vvw 519ov.o /eh g <br /> r. , <br /> i� � `, PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 5r,," b I <br /> ADDRESS: BUSINESS/AGENCY: c. , <br /> 1x41.4 Lir.:d4 Stn4o, F+Tvt�S � ASC.hy(.�5 <br /> PHONE(1):510-$$S — ZI CITE'/STATEIZIP.. Z.µc <br /> TENTgT/VE gppOINTMENTDATE'ONE(2); 910 _yg� R <br /> _bl/dv t � 11 L% Ib <br /> FACSIMILE; (G -_ <br /> (Please slow 10 business 9,99 1 <br /> days from data of appllcadon eubmlmal.• <br /> ❑ Time. <br /> CHECK BOX TO IV"only'InUSt be <br /> EXPEDITE REQUEST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OFAPPLICANT <br /> Electronic Information: DATE -3^3—Z, <br /> o l V <br /> List❑Map-Descrlptlonr <br /> FILE ADDRESS <br /> S}raetp Street Name EHO USE ONLY <br /> 1, City <br /> 2. Ur ° Le{-{rte �fq El unit 1 <br /> IL <br /> 4: 4253 l yd T� Air art ova i L �FltivD �2 \ <br /> nit 2 <br /> 5. <br /> 6. 3 <br /> 7. <br /> n <br /> 8. N <br /> 9. <br /> ❑Unit 5 <br /> 10. <br /> Specific Date Range A Information Requested; From ❑Unit 8 <br /> KENVIRONMENTAL HEALTH DEPARTMENT FILETS to x n-F- <br /> bDEROROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> THkR CLEANUP SITE(NON-LOP) FOOD El <br /> TM C]SOLID WASTE FACILITYNEHICLE <br /> 'NOERGROUND TANK(MONI70PoNG/REMOvgL) ❑tkG KENNEL ©WASTE TIRE <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH El Dagr <br /> ❑TIERED PERNU TED FACILITY WASTEWATER TREATMENT PLANT <br /> ❑MOTEUHOTEL <br /> ❑TATTOO/BODY PIERCING ❑PUMPER TRucK/YggO/CHEMICAL TOILETS <br /> MEDICAL WASTE FACILITY <br /> ❑POOUSPA �!'GND USE APPLICATION SITES <br /> ❑ ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5.,00PM EXCLUDING HOLIDAYS) <br /> 1. L1stub fD A <br /> fen addresses in the space above. Select the typo(s)of files from the list above by checking the appropriate <br /> box(esI. t least one file type MUST be selected. Fax to/2091464-0138 or mal <br /> ranges will not be accepted-for additional assistance with file adtlresses,contact the EHD he ss Indicated above Address <br /> 3:00 Pre will be proceesed the next business day. APPlications received after <br /> 2. The EHDwl11 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 acca di.gly, <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. Anew application maybe <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 /> Futurefile revlews by the same aPP"cant mayrequim a$115 depos it Pilo r to review. <br /> 5. H you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EMP use ONLY <br /> EHD 44-06 <br /> el2Tfe9 <br />