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�I 0 0 <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT 50qq <br /> SON 1 600 East Main St. Stockton, CA 95202-3029 <br /> "Jfio Tone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> RONMS�SERVtGE9 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: cIeH Etti BUSINESS/AGENCY: &*gyv Spnnatjl.loot. <br /> ADDRESS: 31341 YtLnree'.�, -,t2 S& C CITY/STATEIZIP: SawatKevt (A 0. 7.1 <br /> PHONE(1): 1 - 0136 PHONE(2): FACSIMILE: (glbl N8o-0 03 <br /> TENTA IVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST A122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT�,6� 1t -- DATE 70 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street N Street Name City It 1 <br /> t. _ t Ln c 5, N0wtl 3 rj <br /> 2. S. Asqrk _ _ nit 2 <br /> V , 3. <br /> 4. S'�lS _ nits <br /> 5. <br /> 6. b 'l S Unit 4 Ql <br /> 7. <br /> El unit S <br /> 10. ..__._._... nit B <br /> Specific Data Range of Information Requested: From to r <br /> ���� ENVIRONMENTAL HEALTH DEPARTMENT FILES �/ <br /> ✓( rgNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT �S 0 WASTE FACILITY/VEHICLE <br /> �HER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY STE TIRE <br /> DERGROUND TANK(MONRORINGIREMOYAL)�, DOG KENNEL S <br /> ARDOUS WASTE GENERATOR (1C ❑CHICKEN RANCH STEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY p\ ❑r-��Mj'D TEUHOTEL LIMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑��T(A�Tr001BODY PIERCING L✓ OOLISPA FND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILASLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List u0 to tan 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(209)J04.0138 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 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 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 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$122 deposit prior to review. <br /> END USE ONLY <br /> '( d p <br /> - <br /> c2 -i aD <br /> v- <br /> EMD 40-06 C9602;?- Q I-q IDS y Lj 07Q211 0. <br /> 1.00/LOO In \ Y XVA 8£:0L LL07/hL/90 <br />