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1� <br />a <br />OK - <br />q SO EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />4 Z91� ENVIRONMENTAL HEALTH DEPARTMENT 50q <br />600 East Main St. Stockton, CA 95202-3029 <br />(209) 468-3420 Fax: (209) 464-0138 Web: www,sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: &54eN C1,A, BUSINESSIAGENCY: ogyxo, Se ndt kylt, <br />ADDRESS: aK3M FVtar&y" k,* Sia. i' CITY/STATE1ZIP: 5dw,4,e-& rj 0.[ti7\ <br />PHONE (1): R- 07.36 PHONE (2): FACSIMILE: (Skk) 'Ago -0(001 <br />TENTA NE' APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - `Tentative only -must be coldlrmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST A122 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT 091.,•.- V\� DATE A"m W 1?otl <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />ELIMIt 1 <br />, �5, jUJiM i 3 `7 <br />nN 2 <br />Street R <br />1... 1 <br />Street Name <br />City <br />_, <br />Lo e 5 -- <br />2. <br />3. � <br />S. tr�f <br />S . Ac <br />/� i <br />a nn s <br />4. Sz{lS <br />_ <br />5. le2so <br />No t0/ti <br />14 <br />S' 630 <br />S �+0 <br />7. <br />D Unit e <br />6. <br />Specific Data Range of Information Raquestad: From MOD to PxCGe <br />�� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />R�U�I(N, ERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT S D WASTE FACILRYNEHICLE <br />P <br />ER CLEANUP SIE (NON -LOP) ❑ FOOD FACILITY TE TIREERGROUND TANK (MONITORINGIREMOVAL)X ❑ DOG KENNEL RYr',ARDOUS WASTE GENERATOR k ❑CHICKEN RANCH STEWATER TREATMENT PLANT VED PERMITTED FACILITY Q( ❑ kjPTELIHOTEL 4PUMPER TRUCK/YARDICHEMICAL TOILETS <br />�yT�ATTOOIBODV PIERCING OL/SPA LAND USE APPLICATION SITES <br />R. MEDICAL WASTE FACMy ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:0OPM (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 be selected. Fax to f2091 464-0138 or mail 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 H 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 applicatlon may be <br />submitted when the file Is available. <br />4. Any nle 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 $122 deposit prior to review. <br />L00/LOOIn XVJ BEOL I1.07./t+L/90 <br />