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DATE RECEIVED EMD LOG NUMBER <br /> SAN .IOAQUIN COUNTY , 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT lAS <br /> ded 600 East Main St. Stockton, CA 95202-3029 _{ <br /> Q�l 0 1�1Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 2V� fQ'(�-✓I t ^1 BUSINESS/AGENCY: DP��,r gC(p <br /> ADDRESS: 'f�OOA�4ve-4 /5y�1✓ � ,S IeJ 02/. Zq� CITY/STATE/ZIP: 1nCraMP rl'bl/��f9s0��L <br /> PHONE(1): ` �� `17X- %op PHONE(2): l V__17 G?- FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: 1 Time:AMU M <br /> (Please allow 10 business days from date of ap laation submittal-"Tonfatlm Only-mUet be conrlr U ) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(C BWOR C CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT . DATE 2 <br /> Electronic Information: ❑LISt❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Stree!# Street Name City Unit 1 <br /> 1 a✓ vt'_ Im 0 UW s <br /> 2• 2 IP? vc p, on z 3 QUnit2 <br /> � L .I.t7fCj <br /> 4' ( r rD/ O' � Unita I <br /> 5. 10, <br /> 6• L✓ Unit4 <br /> T• �.SU - T �jta�S1. O .f aukS pi !d <br /> 8• ova c� .:S9 .S Units <br /> 9. <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> }}}}����('''�'''� ENVIRONMENTAL HEALTH DEPARTMENT FILES C� <br /> y y.u05SIGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT �S•O,LID WASTE FACILITYNEHICLE7� /fJ <br /> P���rh'OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY &"ASTE TIRE t 3 <br /> „Gy UNDERGROUND TANK(MONITORING/REMOVAL)� *DOG KENNEL DAIRY �t 2 II <br /> 9HATARDOVS WASTE GENERATOR C/j ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT (Z-) <br /> '®,TIERED PERmrTED FACILITY ❑MOTWHOTLL ❑PUNPERTRUCKIYAROICHEMICALTOILETS <br /> ❑TATTOOMODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY XCOMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOUDAYS) <br /> 1. List un to tan addresses in the space above. Select the typo(s)of flles from the list above by checking the appropriate <br /> boxos). At least one file typo MUST be selected. Fax to(2091464.0138 or mail to the address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant if any END files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies 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 END 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 reorganised by END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> rwp IJBE ON4,r <br /> END 4"6 tvt t <br /> Z0/Z0 39Vd ONI -1VH1N3S0b a3QN38 V06VBL69TG 90:£T ITOZ/10/ZT <br />