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0 0 <br /> RrT(M�E 0 SAN JOAQUIN COUNTY EHO LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> til i 7 200° 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.$)gov.D d <br /> ENpEggll Sp! jprL, i PUBLIC RECORDS RELEASE APPLICATION <br /> r <br /> pFRM17L,Fi3tfh,� <br /> APPLICANTLfy �r�,„; BUSINESS/AGENCY: L Crdh 2r0cr.s <br /> ADDRESS: 5q{ L( flafcrn l Avg. CITYISTATEIZIP: Scro,„r , C �5Qai <br /> PHONE(1): qjh t1j�0 Ogg PHONE(2): FACSIMILE: 11h 4�71?rAa� <br /> TENTATIVE'APPOINTMENT DATE: SAA P Time: n,,16. /A(. Y- <br /> (Please allow 10 business days from data of eppllratlon submittal-'7entethne only.must be confirmody <br /> ❑CHECK BOX TO EXPEDITE RE EST-$Y5 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE`4 a T,?j <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street Street Name city Ei unit <br /> �JYy/ 2 I IAl nit 2 <br /> 3. \ <br /> 4. Z<i[3- .\ <br /> 5. <br /> 8• Unit 4 <br /> 7. <br /> 8• ❑Unit S <br /> 10. nH a <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES � <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 4 <br /> SOLID WASTE FACILITYNEICLE C � <br /> OTHER CLEANUP SITE(MONITORING/REMOVAL) <br /> (� [I FOOD FACILITY WASTE TIRE <br /> (M <br /> NDERGROuND TANK ONITORINGIREMOVAL)y\ ❑DOG KENNEL kD1IRYAZARWUS WASTE GENERATOR ❑CHICKEN RANCH ASTEWATER TREATMENT PLANTTIERED PERMITTED FACILITY„/ ❑MOTELIHOTEL MPER TRUCK/YARDICNEMICAL TOILETS t'Y <br /> ❑TATTODIBODY PIERCING N ❑POOIISPA ND USE APPLICATION SITES II/3r� <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) t <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 types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mall 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 H 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 flue 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$116 deposit prior to review. <br /> S. H you need further assistance,please contact Diane Martinez,at(209)468-3426. <br /> PHO use maY <br /> EHD 4846 &Q7Ne <br /> .00/1000 XHd IZ 60 6002/LZ/01 <br />