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LIIIL I\I YILLC <br /> 5106559517 T-954 F 02/05 F-713 <br /> bAN JOAQUIN COUNTY <br /> OVIRONMENTAL HEALTH J7EpgI7�(yjENT <br /> JC18 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: vvwW.Sjgov.O (e <br /> E' <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: iJd712.l,'7.� <br /> ADDRESS: /��.,� w O �(- �E D ST /�!-�y'UFII•E GY�1/NCY; <br /> PHONE(1):(5/09/4-2p 7 O. `� `�� f IT� //� G <br /> PHONE(2) � to Uq <br /> TENTATIVE*APPOINTMENT DATE:�P� )- I Q� FACSIMILE��/�) <br /> (Please allow ten business days from ate o appllcatlon submittal-• ilmR- <br /> CHECK BOX TO EXPEDITE REQUEST- Tentative only-Must confirmed) 1/V_ <br /> SIGNATURE OF APPLICANT $08.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE B�USINESS DAYS <br /> Electronic Information: — DATE �/alpo ' <br /> ❑ List Map-Description: -- <br /> FILE ADDRESS <br /> Sereetu <br /> EH E O LY <br /> 'S <br /> .��� Street Name City <br /> 630 <br /> � Y 5 H - o! .ctTs I unit <br /> 0 WP <br /> V rA <br /> 3 G <br /> d <br /> 1104. w <br /> Q ' Wk1 -YIb SQ" nit2 <br /> I <br /> 5. Yl0 �-Itq 5p to <br /> nit a <br /> Zo tIOab oa(�cd <br /> f�Gnit4 , <br /> 9. nit 5 <br /> do <br /> Specific DateRange of Information Requested:From 0 J� � �`/' " U Units <br /> I�1DO s to 2CO at l <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES zv OAICa <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) q <br /> OTHER CLEANUP SITE(NON-LOP) M HOUSING g9ATEMENT LL,,(( <br /> UNDERGROUND TANK FOOD FACILITY SOLID WASTE FA"ITYIVEHICLE <br /> HAZAROOUS WASTE ENERAO R�REMOVALA' DOG KENNEL WASTE TIRE <br /> TIERED PERMITTED FACILITY T ��O((CHICKEN RANCH 0 DAIRY (Wit <br /> TATTOO/6UDY PIERCING 15t MOTEL/HOTEL O WASTEWATER TREATMENT PLANT (Wit,^� ` <br /> MEDICAL WASTE FACILITY ❑❑POOIJSPA P PUMPER TRUCK/YARD/CHEM TOILETS <br /> WELL AND <br /> SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW(PLEASEOTHER M SPECIFY) <br /> FRlDgy B:00 LAND USE APPLICATION SITES V" <br /> 1. List up to ten addresses In the space above. Select the AMS•OOPM " EXCLUDING HOLIDAYS. <br /> box(es). At least one file tylae(s)of files from the list above b checking the a <br /> not be accepted-for additional ss stancewSelected.file addresses contact the EHp, gpplicatlons received after s r pm will <br /> 4-0138 or mail to the ahove atldress.g appropriate <br /> be processed the next business day. Address ranges will <br /> 2. The END will notify the appllCant if any END flies exist. An appointment <br /> days offer receipt of application. The files will be held for a maximum of Five bus n businessdays for be rew'ew. Appointments <br /> Should be scheduled accordingly. pproximately ten <br /> 3. A file that b actively being worked on la the END staff may not be immediately available For review. Anew application <br /> maybe Submitted when the file is available. <br /> 4. Any file not returned in the same Condition as released will be reorganized by END Staff at the expense of the plplicant. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> END USE ONLY <br /> EEND48.06 10!29!0] <br /> PUBLIC RECORDS RELEASE APP FORM <br />