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SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ZQ11 ENVIRONMENTAL HEALTH DEPARTMENT '02 r-1 <br /> SUN 600 East Main St. Stockton, CA 95202-3029 <br /> 0*one: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> �R 1�tilsE�0-S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:&%ZeN Qtt+, BUSINESSIAGENCY: �rYewoY. "tet (v"' <br /> ADDRESS: -sq%4 M&Nw : '6 %Ae, C CITY/STATEIZIP: xYewevt�Ot T_���t�.7t <br /> PHONE(1): R - 07.16 PHONE(2): FACSIMILE: (416 N8o-o6D3 <br /> TENTA WE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal- Tenmtlw only-must be comlrmod) <br /> ❑CHECK BOX TO EXPEDITE REQUEST A 122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 70 <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street s Street Name City It 1 <br /> 1. 1 L,o c 5 _.. , O l`5, NDUn 13 `7 <br /> 2. S. tr-�r'� ._ — nk 2 <br /> 3. ssoa '&. & o Cal <br /> 4. Syls <br /> nit 2 <br /> 5. 1,260 N0�(5v" <br /> 8. 63W S <br /> Unit 4 <br /> 7. <br /> -^-- Unit a <br /> 10. �..,._.� <br /> nh s <br /> Specific Date Ranee of Information Requested: From 1900 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> r;� t{"� <br /> 01INDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT CJ S D WASTE FACILIYNEHICLE <br /> 2 HFR CLEANUP SITE(NON-LOP) C3 FOOD FACILITY STE TIRE <br /> ERGROUND TANK(MONDORINGIREMOVAL)X ❑DOG KENNEL ILWAND <br /> RYARWUS WASTE GENERATOR k ❑CHICKEN RANCH STEWATER TREATMENT PLANTTIERED PERMITTED FACILITY Q� ❑ TELIHOTEL MPER TRUCK(YARDICHEMICAL TOILETSryT�A�TTOOIBOnY PIERCING �WIJSPA USE APPLICATION SITES <br /> L� mtuICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTLC PERMIT RECORDS ARE AVALADLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List Do to ton addresses in the space above. Select the types)of Tiles from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to/20914840138 or mail to the address Indicated above Address <br /> ranges will not be accepted•for additional assistance with file addresses,contact the EIAD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The END 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 or 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 /> submifiad when the file is available. <br /> 4. Any file not returned in the same condition es 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 /> END ME ONLY <br /> -I r 0 <br /> 44,W file, 04d tOAlifix <br /> Y11 re <br /> tool f <br /> (00027(00 (qod I'q lD3 y Li ) � �oluao <br /> L00/1001A \ XVA REAL LL07/bl/90 <br />