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v <br />DVL <br />SAN JOAQUIN COUNTY EHD LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT �Oqq <br />600 East Main St. Stockton, CA 95202-3029 <br />ap(Mihone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FrMR�NniTiSERNCEs PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: &SkK Qt A, BUSINESSIAGENCY: Ey Apv% SPS6 <br />s <br />ADDRESS: 3il13q _ Du'fte" t¢ sk C CITYISTATEIZIP: rCA n&jj% <br />PHONE (1): 1_�,1go-0-.3b PHONE (2): FACSIMILE:-%0-0(*0-5 <br />TENTAffIVE' APPOINTMENT DATE: Time! <br />(Please allow 10 business days from date of application submittal -'Tenfefive only • must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - i22 FEE (CASH OR CHECK ONLY). REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT 4C...- V , DATE gua 1' toll <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />ELIMII t <br />_ nH 2 <br />a <br />street # <br />Street Name <br />City <br />2. <br />3. <br />5503 <br />s, I\tr�rT <br />S. &rwrk <br />a• <br />�,�{Zs <br />Vnit <br />WUait 4 <br />8• <br />{� <br />S <br />T. <br />p Unit a <br />8. <br />__..—........ <br />nit S <br />Specific Data Range of Information Requested: From (aloe to �'rCrt <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES c I�✓�,',ryl� <br />NOERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT S ID WASTE FACILRYNEHICLE ) `-I r(Y✓yJ�'� <br />RITHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY STE TIRE � � <br />iU DERGROUHDTANK (MONRORINGBEMOVAL)D(, ❑DOG KENNEL RY <br />ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH STEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY L7( ❑�, WTELIHOTEL VLAND <br />MPER TRUCKNARDICHEMICAL TOILETS <br />ZIT[A�TToOIBODY PIERCING Lv1Y0OLISPA USE APPLICATION SITES <br />R`MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-$:OOPM (EXCLUDING HOLIDAYS) <br />1. List un 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, 8138 or mail to the address Indicated aboyg, 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 H any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br />days after receipt of application. The flies 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 />a. 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 />100/1001A XVj 80:01. 1107/bL/80 <br />