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A <br />4oI. S. 2006 10:34 R"'gWN & I17'VTER. <br />N0.0660 r. 1!1 <br />DATE Rg ,EEv( [) _ EHD LOO NUMBER <br />F_- LI ��� �� SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT�� <br />g Zppg 600 East Main Street, Stockton, CA 95202-3029 � <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wwW.sjgov.Gr eh j0 <br />NtiT HEALTH <br />7 'SERVICEg PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: fir, h It1�4..����``tUr hGCU .F� C' BUSINESS/AGENCY: <br />ADDRESS:- (W �VVTA\wwr�tM �A 1V�. ��¢ kl1 b <br />PHONE (1) 156) Vn—'44W,!t PHONE (2): FACSIMILE: ,� <br />`` TENTATIVE" APPOINTMENT DATE: Z 3 oX Time: IO� OO G • r^ , <br />(Please allow len busi Sys from date or ap limdon submittal - •Tantatfve only - must be confirmed) <br />CHECK BOX TO EXPEDITE RE EST- 98.0 FE AS 0'R CHECK ONLY) - REQUES <br />(CT PROCESSED IN THRE BU INESS DAYS <br />SIGNATURE OF APPLICANT DATE D <br />Electronic Information: f List 0 Map - D-ption: <br />FILE ADDRESS END USE ONLY <br />street tI <br />345 <br />Street Name <br />city O Unit 1 <br />ti t, s oz�"oz5( Z)Ko5"dia-f <br />►-ih aizl t <br />0 <br />NQ1 1satin . fil•Y` e <br />S V VI �J(\(d�Z,"OES(D2).kny q ❑UnIt2 <br />V1�' N Oce V %�f dT]' <br />h <br />N. 56t o" Will <br />stb " (( 67.) uST(oz ;ues�z <br />r( 0 7, '',XA Y c 41-.- <br />vr5r <br />rN mom <br />)rC (t'v� iLL' nh d <br />W F►G!M 1 <br />J �d 'NO — • r iFF E3Umt5 <br />/le 4b :raw bP' cAyr /V 61 <br />. Fh waw <br />q3p <br />W • 1, nd s St . <br />SfrektrK Ko &h ,i w � �.t,-N nit 6 <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES n/ <br />j(NDERGROUNo TANK (UST) CLEANUP SITE (LOP) 4 HOUSING ARATEuENT D7 un WASTE FACILITYNEHICLE <br />GTSITHER CLEANUP SITE (NON10P) t7 FOOD FACILITY D WASTE TIRE//�l� <br />NDERGROUND TANK (MONITORING/REMOVAL) RDOG KENNEL DAIRY <br />3;1A RDOOS WASTE GENERATOR CJ CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br />D TIERED PERMITTED FACILITY 0 MOTELIHOTEL D PUMPER TRUCKIYARDICHEM TOILETS <br />0 TATTDO/BODY PIERCING D POOLISPA 0 LAND USE APPLICATION SRES <br />0 MEDICAL WASTE FACILRY O OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAY& <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 (2921 ftR]38 or mal to the abov address. Address ranges will <br />not be accepted -for additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm will <br />be processed the next buslness day. <br />2. The EHD will notify the applicant it any EHD files exist, An appointment for review will be confirmed approximately ten <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 the EHD staff may not be Immediately available for review. A new application <br />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 applicant <br />Future file reviews by the same applicant may require a $88.00 deposit prior to review. <br />END USE ONLY <br />