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Flow lglarcus H. Bole & Asso0S 530+633+0119 12 1009 16: 12 #140 P .001 <br /> U MEOWED SAN JOAQU(N COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Z009 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIRUNMLNT REALTFi-lephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.o <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: [t " l-'. BUSINESSIAGENCY: DZCL7,1C <, <br /> ADDRESS: AU -&rd fL z r/,t e City/statelzip l rf��a Ila, — <br /> PHONE(1): 1/ 7 PHONE(2}, �C-_y,/-- (- 1�FACSIMILE: L1 -(x.33" e" <br /> TENTATIVE*APPOINTMENT DATE:_f a�7 Time: Ll <br /> (Please allow 10 business days from e of application submittal-"Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT - �� � C �Zr?�-,� _ _ DATE /2� 0 <br /> Electronic Information: [] Lisa❑ Map—Description: <br /> _ FILE ADDRESS _ EHD USE ONLY _ <br /> Street# _- Street Name _ City Unit 1 <br /> 2. b it2 / <br /> _. ! <br /> � JUT- <br /> FAm ljn/4p <br /> r <br /> 4. �51.�i� it [,t`> Unit 3 �t1 <br /> ❑ Unit4 <br /> 7. <br /> Unit 5 <br /> L190 <br /> . / Gj/ C%ter ltJ c I // Qt, No U? 1� <br /> Specific Date Range of Information Requested: From to � <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,f' UUNDERGROUND TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATEMENT cr OLID'WASTE FAC4LITYIVEHICLE <br /> 4 <br /> d VTNER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ©WASTE TIRE <br /> Q-t�_NERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY /J 4 <br /> 9A4AZARDOUS WASTE GENERATOR 17 CHICKEN RANCH 17 WASTEWATER TREATMENT PLANT 1v? <br /> 11 TIERED PERMITTED FACILITY ❑MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> M TATTOO/BODY PIERCING 0 POOL/SPA CI LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 17 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 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(209)454-1}138 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 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 of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 1 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-86 8104108 PUBLIC RECORDS RELEASE APP FORM <br />