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DHI E <br /> SAN JOAQUIN COUNTY <br /> �!! <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ek.bo 9 U10 600 East Main St. Stockton, CA 95202-3029 <br /> NVIRUNMENT HEALTH Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.o /eh <br /> p(_RMITIS WCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: OI.IuER YAnj BUSINESS/AGENCY: OVNE-STOI.A- ILovt-rLS ASEoc.IA'Th <br /> ADDRESS: IORG`t -rfZAPe elrtEl)z DRlvr• &VM 107 CITYISTATEIZIP: &6 , rn1200YA , CA <br /> PHONE(1): �1I(e)%rl-M9g PHONE (2): ��7t(o� °t- &9M FACSIMILE;_(gffo) <br /> TENTATIVE*APPOINT'MENTDATE: It7-l3-10 /a• s�ner� Time: I: ?pn r <br /> (Please allow 10 business days IrOT ppllcatlon submittal-'Tentar/Ve q ly•must be confirmed) <br /> ❑CHECK OOX TO EXPEDITE REQUEST- 2Z E(G H OR H GK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE CD <br /> Electronic Information: ❑ List❑ Map- riptl <br /> -,-FILE ADDRESS EHD USE ONLY <br /> Street Street Name City <br /> C Unit 1 <br /> 1• 425 FA4TN Q �i/P(Le'YtA. L.RTH2oP '"° U5� ,OE�I '::� <br /> 2 Ig�3� SOLtT fit R T11RoP hMrtt radajbN4 3 arm Unt2 <br /> 3. f;0xmf9 5 4Y AA SYF[Tp1TIFw WIvIT + V.AIR SLT WAY AN I , <br /> oc� (�f <br /> 4. HR rt6 <br /> Unit 3 <br /> 5. <br /> 6. <br /> Unit 4 <br /> 7 <br /> B. <br /> 9 ❑Unit s <br /> 10. <br /> punNs <br /> Specific Date Range of Information Requested= From - to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I9 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE :✓ <br /> ®,OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WA81'r TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL)K ❑DOG KENNEL ❑DAIRY -"' <br /> ®HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELfHOTEL <br /> ❑TATTOOIBODY PIERCING ❑PUMPER E APPUCARO N SITES TOILETS <br /> ❑PODUSPA LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. URI up to ten addresses In the space above. 5elact 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)464.0138 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 EMD 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 /> 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 Nle not rawmed 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$122 deposit prior to review. <br /> -END USE ONLY <br /> Lhie710/7 <br /> 1 <br /> run vsa n7mmn <br />