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1 E C + " E <br /> DATE RECEIVED <br /> jUN I 0 Luo ,SAN JOAQUIN 'COUNTY EHD LOG NUMBER <br /> ENV1RQNj(jEP,fF ' ENVIRONMENTAL HEALTH DEPARTMENT <br /> `��°��RI��rIS�Rt f��� phone: (zasj asp-�4zo Main <br /> Stockton, CA 95202-3029 <br /> ( )464-018 Web: www.sjgay.org hd <br /> Ca en l,�if P BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 ?tl�:I�l <br /> E3USINESSlAGENCY: <br /> anoREss: U��i G�l� <br /> PHONE 1(6 � - CITYrsrAT�IZIP: . <br /> ( D= � �� PHONE(2):r xr �{A6 7f�.-``'q'YFACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Piga6e allow 10 boslness days from date of appllcatla submittal-*T Time: <br /> Q CHEGK BQX TO t~XPEQITI REQUES $1 FEE entattve only-must be confirmed) <br /> !«CK ONLY)-REQUEST pROCE$St p IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE�-)n-P— O <br /> lalt�Ctronic Information: [�List Map–Description: <br /> Apq�>~gS a:liD USE ONLY <br /> Street#FTFILI <br /> treet Nama <br /> City <br /> - <br /> 3. Unit 2 <br /> 4. r! <br /> ,6. r �lt} f------------------ <br /> Unit 3 <br /> t1 v <br /> y. <br /> n44 <br /> 8. <br /> 9. Unit5 <br /> 10. <br /> specific date Range of Information Requested: 1 remQ. 'Unit 6 <br /> to <br /> t~NVIRON114EHTALHEAL TH ARTMENT KES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q HOUSING ABATEMENT <br /> OTHER CLEANUP SITE(NON.LQp) Q FOOD FACILITY 0 SOLID WASTE FACILITYNEHICLE <br /> ®.t1NI)ERGROUND TANK(MCWTORINGIREMOvAL) Q DOG KENNEL 0 WASTE TIRE <br /> Q HAZARDOUS WASTE GENERATOR []CHfCKEk RANCH Q DAIRY <br /> Q TIERED PERMITTED FACILfTY b El WASTEWATER TREATMENT PLANT <br /> TATTDOIUppy PIERCING MOTELMOTI L [�PUMPER TRUCKrYARpICHEMICAI TOILETS <br /> Q MEDICAL WASTE FACILITY Q POOLISPA d LAND USE APPLICATION SITES <br /> 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY$:00 AM-5:00pM(EXCLUDING H )LIpAYS) <br /> 1. E_lst u210-1001 addresses In the space above. Select the type(s)of filus from the list above by shacking the appropriate <br /> box(es). At least one Life type MUST be selected. F x to 209 464-0138 or mail to the address indicatad above_ Address <br /> rangos will not be accepted-for additional asSIStance with filo addresses,contact the EHD. Applications received after <br /> 3:00 pm will be pruc4s3ed 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 Fifes 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 reteasud will be reorganized by EHL)staff at the expense of the applicant. <br /> Futuro file reviews by the same applicant may require a$945 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)469-342b. <br /> EMD USE gry�y <br /> EijL7 A8-06 <br /> &2rroe <br /> TO/10 3DVd ONI -1VHiN9506 H30N3g b0608Lb9T6 TT:bT OTH/01/50 <br />