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DATfxH6y <br /> rEe N 0 SAN .IOAQUIN BOUNTY • EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> '7 011 W <br /> - 600 East Main St. Stockton, CA 95202-3029 <br /> �N 1Ror 1rnEN��IF?RgW: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.orglehd <br /> RER;�wSEr,�(orSPUBLIC RECORDS RELEASE APPLICATION y <br /> APPLICANT: I�nr� r: BUSINESS/AGENCY: c te // 1 cts l o t <br /> ADDRESS: 31134 CITYISTATE/ZIP: era 7a 9Srs'� <br /> PHONE (1): 91� qV$2 PHONE (2): FACSIMILE: 14 ,y 03 <br /> TENTATIVE"APPOINTMENT DATE. pe. l( it 5rw iJt, Time: <br /> (Please allow 10 buelnesv days from date of application submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQ EST-$1 2 FEE(CASH OR CHECK ONLY),REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE P�9,V- I I <br /> Electronic Information: [-] List Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street If Street Name City 1 <br /> i <br /> t. 3u55pa C <br /> 2• �J l g C> `f 5100 �- > rs Unit 2 <br /> 7 <br /> 3• 3 3� u + ,Oe S, of •r5 <br /> 4. k ( &.O 3 <br /> 5. <br /> 8. . ❑Unk4 <br /> 7. <br /> 8. <br /> ❑Unll S <br /> 10. <br /> ❑Unit 8 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILNYNEHICLE t� <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)%/ ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATORdI-- ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOO/600Y PIERCING ❑POOLISPA ❑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•5:00PM(ExCLUDING HOLIDAYS) <br /> 1. List uo 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 2 138 or mall 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 If any EHD files axiet. 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 /> EHD USE ONLY <br /> 3� <br /> s5D <br /> END 4e-0e 07129Ma <br /> 100/I.00n Nva Ll : tl LIOZ/bZ/Ol <br />