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LFR x:5106524906 Nov 30 10015_ 16:31 P.01 <br /> f f <br /> DATE RECEIVED �,' � � EHD LOG NUMBER <br /> D SAN JOAQUIN COUNTY <br /> hC <br /> ENVIRONMENTAL H AL H DEPARTMENT <br /> MENT <br /> 304 East Webor Avenue 3`d Floor, Stockton, CA 95202-2708 <br /> 6yNU V S 0 2005 Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> Z105 (0 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLJCANT: „ ' { BUSINESSIAGENCY: jJ k!~ FY7 G <br /> AODRESS: 1900 OWW %_ rZ <br /> PHONE(1): 5(o— Set 0 PHONE(2)- —FACSIMILE:_�)�7'�a�2- �ab <br /> TENTATIVE*APPOINTMENT DATE: Time: T <br /> (Pismo allow 11)buslnsss day@ from data at application submit#al.*Tentative only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQUEST-$93.00 F R CHECK ONLY).REQUEST PROCESSED IN 3 BUSINESS PAYS <br /> SIGNATURE OF APPLICANT DATE F t S= 6C <br /> UNIT DISTRIBUTJON 6UNWI ❑ Unit Z G Unn 3 ❑ Unit 4 O Unit 6 ❑ UnitO C1 Other(electronicllrstslmaps) <br /> FILE ADDRESS EHb USE ONLY <br /> street# street Nome Cloy <br /> ik <br /> 2, -7TH <br /> 4. <br /> S. <br /> 7. <br /> 8, <br /> 9. <br /> 10. <br /> Specific Date Range of information Requested: From Belo O p <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES .� <br /> UNDERGROUND YANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE PAC;UTYIVENICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONMORINGIREMOVAL) 0 Doe KENNEL O DAIRY <br /> XHAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERUnTED FACILITT ❑MOTWHOTEL 0 PUMPER TRvoKIYARDICHEM TOILETS <br /> 0 TATTOO/Swy PIERCIl a ❑POOLISPA ❑LAND UBE APPLICATION SITE$ <br /> 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMR RECORDS ARE AvAILAl3LE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5,00P” - EXCLUDING HOLIDAYS. <br /> I. List up to ten addresses in the space above. Select the type($)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. EA&12.12091464-0138 Qr Mail to the addr <br /> glig <br /> hated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm Will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHb files exist. An appointment for review will be confirmed <br /> approximately tan(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD 46.OZ4M <br /> 1!1405 <br />