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BATE RECEIVED EHD LOG NUMBER <br /> SAN .IQAQUIN COUNTY <br /> D (� (�(��1+(/( © ENVIRONMENTAL HEALTH DEPARTMENT <br /> L�U� I� J LE 600 East Main St. Stockton, CA 95202-2708 <br /> AUG <br /> 1 7 27Mephone: (209)468-3420 Fax: (209)464-0136 Web:www.sjgov.or <br /> UUUU�� PUBLIC RECORDS RELEASE APPLICATION /� <br /> Sk <br /> APPL'f�Af�:`��'�1�+rf f5 �/ _�-'I�t� BUSINESSIAGENCY: 1�Ol,CtC n <br /> ADDRESS: c�Q O1 -PT2t2 ShZat CITy1STATE/Zlp: -r-" a-' N\/ <T�9 <br /> PHONE(1): 63( -A3 -d(, >0 PHONE(2): FACSIMILE: G3/-o13 91 a e <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 buslnass days from^of application su 1-'Tonattive only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-S11 .00 F E(CASH OR EC O I - EQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> ElecVonic Information: ❑List❑Map-Description: <br /> FILE ADDRESS ELIO USE ONLY <br /> I' IS 9 Street Name Gty ❑Unit 1 <br /> 1• O S f S /tlo L.Lot j <br /> �J 2. nn1 <br /> 3. <br /> 4. Unit s <br /> 6. Unit4 <br /> 7. <br /> 8. [3 Unit 5 <br /> 8. <br /> 10. O Unit B <br /> Specific Date Range of Information Requested: From /M to � <br /> rr��--�,r....�� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ftDERRGROUND TANK(UST)CLEANUP StrE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FActUry VENICLE q <br /> CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE J-Oil � <br /> tttt}ONDEROROUND TANK(MONITONNGMAOVALK F]Boa KENNEL El DAIRY (r1idOl <br /> FHAZM❑ <br /> DOUS WASTE GENERATOR Q( ❑CHICKEN RANCH ElWASTEWATER TREATMENT PLANT G` <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PAMPER TRUCKfYAWCHEMIEAL TOILETS <br /> �]TATTooI800Y PIERCING ❑POOLISPA ❑LAND USEAPPLICATION SUES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uo to tell addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(os). At least one Ole type MUST be selected, Fax to l209146aA138 or mall tD the address indicated above. Address <br /> ranges will not he 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 if any EHD files exist- An appointment for review will be confirmed approximately ten(10) <br /> days atter recelpt Df application. The files will behold 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$115-00 deposit prior to review. <br /> eHe use ONLY <br /> eetYf you meed further assistance please contact Diane Martinez a (209)468-3425 directly. I nom 7m--- <br /> BID".0 Z <br /> m---B"p~ed 'd 6908 'ON 8686-ZH-[E9 '0NI 'S31VD0SSV X 08 Nd9E 6 60H 'Ll WV <br />