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U UE�T'�'--'I�WED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ✓;I It l 209 ENVIRONMENTAL HEALTH DEPARTMENT n <br /> 600 East Main Street, Stockton, CA 95202-3029 C <br /> EDAM M MENT HC Sj�Iephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.o <br /> PUBLIC 11RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 �a N. <br /> Ol_ BUSINESSfAG/E�NCY: F—k* <br /> ADDRESS: C-8o <br /> �N. .W� ,,,/118!0. Ave.MJ�,* Q city/Statelzip IQ;0 Z0-- q <br /> PHONE(1): ZSR 4C'Y T10lfT PHONE(A2):: VA �Zl - 2a&S- FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: IMAfip'lti rA2oa0� Time: a Q,4XA <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE RET- 0 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ y_ DATE �-Z!-07 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street* Street Name ' City -_- ---- ❑ Unitt <br /> 1. 14 0— C Sr. o __ NFJ19 mocdcp- <br /> 2- 1 t� W. i)SL° Ma 2ca w,oEs eisP Unit <br /> v 3. Mao 0- VC. .1, F, 3 <br /> 4. oja(D Z�,llESI va op <br /> 5. / SI S _. .. U57 Lo Unl! r\1 <br /> Unit4-- <br /> 6. I uyaa�i5 r' <br /> Dal <br /> cI ynit s <br /> 5. aaa o sly . <br /> 10. ao ;n , 01 >, e <br /> Specific Date Range of Information Requested:From Ca•r Ir4tJ- o Y4o4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,�r UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEHICLE <br /> M <br /> OTHER CLEANUP SITE(NON-LOP) CI FOOD FACILITY 0 WASTE TIRE <br /> ,yX,y�U��NOEROROt1ND TANK(MONITORINdItiEMOVALW Cl DOG KENNEL O DAIRY yl <br /> x�nAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY ❑MOTEL/HOTEL O PUMPER TRUCKIYARDICHEMTOILETS <br /> 0 TATTOO18ow PIERCING 17 POOL/SPA 0 LAND USE APPLICATION SITES <br /> E3 MEDICAL WASTE FACILITY 0 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 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(2091464-0135 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 if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will behold 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> 4- ,� Na d J i <br /> Ip e <br /> i 0.J <br /> q n d- NJb 6405- n 5V-� 14 <br /> - <br /> EHD 48-06 W04/08 PUBLIC RECORDS RELEASE APP FORM <br /> ZO/TO'd 66TO 998 SEG T U311jHodJOONi 030N3 ££:9T 600E-TZ-Jdt1 <br />