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h SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-30N <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: vVwvv.sj9ov.orI;L1e5tbT <br /> 1_1 I PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Br-,, <br /> ADDRESS: l.,xiA Lre:Ae_ C..Ipr g;A <br /> CITY/STATE/7JP:_T-a-,,iry 4yydr&-q:, C. JRi476 <br /> PHONE PHONE(2); litig -IgS7 -0";6n FACSIMILE: ql& -RA- 999 <br /> TENTATIVF'APPOINTMENT DATE:—_ Time, <br /> (Please allow 10 business days fro.data ol"Polleation�8.bmfttaI-•Tenfa(,vonly.must be confirmed) <br /> E]CHECK SOX TO EXPEDITE REQUEST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT V�L� DATE I (> <br /> JElectronic Information: [I List El Map-Description: <br /> FILE ADDRESS EHO USE ONLY <br /> Street# Street Name I City [I Unit I <br /> 2. 2 <br /> 3- LIZ-5 3 ll '50trw ArTA14 W <br /> 4 0-7, E CO <br /> . 1 <br /> S. <br /> 6. <br /> 7. nit 4 <br /> 8. <br /> 9. 0 Unit 5 <br /> 10. El Unit 6 <br /> specific Date Range OfInforrnatim Requested: Fromi <br /> ENVIRONMENTAL H05-H DEPARTMENT FILES to n-1 <br /> " <br /> OUNDERGROUND TANK(UST)CLEANUP SITE(LOP) Ll HOUSING ABATEMENT Ll SOLID WASTE FAciuTYNERICLE <br /> 4!j OTHER CLEANUP SITE(NON-LOP) F]FOOD FACILITY MWASTETIRE All <br /> LNNDEXROUND TANK(MONITORINGIREMOVAL)O�, E]DOG KENNEL Elowy f.3 <br /> 1 • <br /> [I TFIRED PERMITTED FACILITY -1 WASTEWATER TREATMENT PLANT r-'s 311-1yo <br /> /J HAzARDous WASTE GENERATOR ❑F-1 CHICKEN RANCH E <br /> ❑ [:1 MOTELIHOTEL El PUMPER TRucKfYARD[CHEmjCAL TOILETS <br /> PIERCING [I POOUSPA ❑ <br /> ��O USE APPLICATION SITES <br /> Ll MEDICAL WASTE FACIUTY F]OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 AM-5:00pm(EXCLUDING HOLIDAYS) <br /> List uo fe-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 L209)464-0136 or glitil 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 proceesod 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 ton(10) <br /> days after receipt of application. The files will be held for a maximum of live business days for review. Appointments <br /> should be scheduled aurpr4bgly, <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 deposit prior to review. <br /> 5. If you need further assistance,please contact Diana Martinez,at(209)468-3425. <br /> EMP U59 ONLY <br /> Wz20 <br /> .0 J 72 :2 &42&z2fe- 5-5 7 WMIPUM I- I- I <br /> U202 9 <br /> EHO 0-06 <br />