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WED 0 0 EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 2 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/e S 3 <br /> YP <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: S V1(0�1 f .MC 5401 Vlrr'�tBUSINESS/AGENCY: <br /> ADDRESS; ��j,., /y 0 rYn1JM, 11-7t" U p � c+2•^n /�/ <br /> PHONE 111: ✓. 24 — & C. PHONE(2): ld'�Ob�� ���� FACSIMILE: �73t/'"lo - (�S <br /> 7 qq L, <br /> TENTATIVE*APPOINTMENT DATE: U� Ot ZDDS Time: O.d <br /> (Please allow ten business dayug m date of application sgpmittal--Ten fiveonly-mus co irmed) <br /> �p�I (A m�.ona Fiala are ',A % �DSSi(k' ad� J44 <br /> ❑ CHECK BOX TO EXPEDITE REQU.STT}-$98.90 F E(CASH OR CHECK ONLY)-REQUEST ROC SSED INT EE BUSINESS DAYS <br /> SIGNATURE OFAPPLICANT DATE S—rS'OS <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street Street Nama city ❑unit 1 <br /> 7. ({ a� (.i��J��L)ISC I �ry <br /> t�10 Jf Z• L WD w 5 J5 Malt 0(s Jp AW taj�.lf�COI"lf ❑ Unit <br /> 3. v L'In 3 SCk hM ,Ln a <br /> q. nlca' ��D <br /> 6. Y1US "ty` UVI na <br /> 7. <br /> $ 0 Units <br /> 9. <br /> ❑units <br /> 10. T <br /> Specific Date Range of Information Requested:From J4 � to 94 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> *UNDERGROUND TANK(UST)CLEANUPSrTE(LOP) O HOUSINGARATEMENT E3 SOLID WASTE FACILITYJVEMCLE <br /> I7 OTHER CLEANUP SITE(NON-LOP) 71 FOOD FACILITY C1 WASTE TIRE <br /> WNDERGROUND TANK(MOMTORING/REMOVAL) 0DOG KENNEL GDAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 11 WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY 13 MOTELtHOTEL O PUMPER TRUCKNARDICHEM TOILETS <br /> TATroofSODY PIERCING 17 POOLISPA ❑LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY D OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMrT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 Awli:OOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(S)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected, Fax to(2091464-0138 or mail to the above 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 business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten <br /> days after receiptof application. The files will be hold 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 he submitted when the file is available. <br /> 4. Any rile 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$06.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 43-06 10nW07 PUBLIC RECORDS RELEASE APP FORM <br /> Z0/Z0 39Vd dIldU ON Snivdis 90099L90E9 9Z:60 80OZ/91/90 <br />