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[ � SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> A 'id 2 17009 ENVIRONMENTAL HEALTH DEPARTMENT qZ95% <br /> 600 East Main Street, Stockton, CA 95202.3029 <br /> ENA )LAMENT E S}TIephone: (209) 468-3420 Fax: (209)464-0138 Web: WWW.sjgov.o <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: r �e1a o� BUSINESSIAGENCY: F-^w�GEO <br /> ADDRESS: C"B0`- N, .--,W� ,t,�W1 in- AV<- Jft A �7 City/State/zip rcl� l.P' q <br /> PHONE(1): 2,Dq to 710V PHONE(2): � A bbl — Z�a�O,� FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: MPrC(•, S'i 7'OOq Time: ett�o AM <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 //1 I DATE 2!'O�I <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 1t Street Name ' City <br /> ----- ❑ Unitt <br /> CIC Sr. c, D <br /> 2• W. O5L M 2Cv w,0ES mise unh2 <br /> v 3. N. m p- vcC n, <br /> - b / / <br /> 4. aao USS 2�IUESINo LD/op Unit <br /> V <br /> o <br /> Unit4 <br /> LJ Units <br /> 8.-- . aao .aly _- <��<;� <br /> units <br /> 1D. ad .n o S i Uhf LorO JV <br /> Specific Date Range of Information Requested:From Cer llel-- o N164 <br /> ....eeee��� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> "I UNDERGROUND TANK(U5T)CLEANUP SITE(LOP) M HOUSING ABATEMENT O SOLID WASTE FACILITYNEHICLE <br /> ( <br /> OTHER CLEANUP SITE(NON-LOP) ' // 4 FOOD FACILITY ❑WASTE TIRE <br /> P.y�y//'U'��NWACIROUND TANK(MONITORIN(r1f2EMOVALry(- 13 DOG KENNEL EO DAIRY <br /> ✓�HAZAR000S WASTE GENERATOR 0 CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY ❑MOTELIHOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> 173 TATTOO/Born PIERCING 17 POOUSPA O LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY•FRIDAY 8:Oo AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up 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 to(20)464-0138 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 if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be hold 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- c- ( a N� 4( ... <br /> r)- _ Uri rj2le, <br /> q n a bfo (v y. n&LS. <br /> EHC 48.08 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br /> EO/To'd 66TO 998 S26 T Q31FJb0daODNI 0301,13 Lf:9T 6002-TZ-add <br />