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DATE RECEIVED EHD LOG NUMBER <br /> SAN .�OAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3 I Floor, Stockton,CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION e r <br /> APPLICANT: kera4 BUSINESS/AGENCY: FrIC JIr7?/{7Atiih6l <br /> ADDRESS: ,✓,1xs Morello '4"nW , R arant 6 12�'tlg 3 <br /> PHONE 0): 9.75- -WV -4 F IC X41 PHONE(2): V5-W�r0 -.5' 36 lPz//) FACSIMILE: 7.20 <br /> TENTATIVE'APPOINTMENT DATE: 11L11fY i1.G1�•--•3✓e?00 t Time: /0� <br /> (Please allow 10 business days fromAlto of ap kation submittal-'Tentaaw only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST�-/$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT rvltGGGti✓. PGt(iG�I_� DATE <br /> Electronic Information: © List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# street Name city ❑ Unit 1 <br /> 1 <br /> sot al Cfiartar W441c <br /> 2. sJs W chmae Wk ❑ Unite <br /> 3• 4,;0 W C rhw WkJ�dc m e <br /> 4- <br /> s <br /> 441 NlCluartwir a <br /> 5. k'r Wa �tvckr�� <br /> (4G S units <br /> 6• <br /> 7. <br /> ❑ urns <br /> 8. <br /> 9. <br /> Unit 8 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 16 UNDERGROUND TA14K(UST)CLEANUP SITE(LOP) d HOUSING ABATEMENT G SCUD WASTE FACNJTYNEHICLE <br /> 'eOTHER CLEANUP SITE(NOWLOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> /r!UNDERGROUND TANK(MONRORING/RENOVAL) 0 DOG KeNNEL 0 DAIRY <br /> ./.+HAZARDOUS WASTE GENERATOR El CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> yCf TIERED PERMITTED FACILITY 13 MOTSIJHOWL 0 PUMPER TRUCK/YARDICHEM TDILETs <br /> 0 TATTooMoDY PIERCING ❑POOLISPA 0 LAND USE APPLN:Anom Sires <br /> O MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERAr RECORDS ARE AVAILABLE FOR REYIEW - MONDAY-FRIDAY 8:00 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 be selected. Fax to(20M 454-0138 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 N any EHO 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 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 EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> ENDasm W25n <br /> TO 39Vd Hd 9NIa33NI9N3 DI13 OZLVZ099ZGT Z0:60 900Z/ZT/ZI <br />