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DAYII�E£ )V C SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> 1 1c9AOI 29 zon E*ONMENTAL HEALTH DEPARAT <br /> 600 East Main St. Stockton, CA 95202-3029 t _ <br /> ENVIRONMENTALI-W*one: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd ,Y/V/j <br /> PERMITISERVICES' <br /> 0 <br /> PUBLIC RECORDS RELEASE APPLICATION 11 ^ <br /> APPLICANT: IL55.0 IVV�{�/�t�l�I/t^�l BUSINESSIAGENCY:_ cs �Sc�CiGt 6�S <br /> ADDRESS: S r1I 5CITY/STATE/ZIP: <br /> PHONE (1): 2pZ— l-710- !G3 oe PHONE (2): FACSIMILE: 1 g - 07— C)00' <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEEA(C—ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINES DAYS <br /> SIGNATURE OF APPLICANT /v DATE ; ,z 1) <br /> Electronic Information: ❑ List EY Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City u ❑ Unit 1 <br /> 2. Nam. Unit2 <br /> 4 • Unit 3 <br /> 6. p '� GJ OGQ 5 -e/Unit 4 <br /> 7. <br /> 8. <br /> ❑ Unit 5 <br /> 9. <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> Iq' ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Ri UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE 1'J '''"""���/// <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE f ' A. $,qX <br /> UNDERGROUND TANK(MONITORINGIREMOVALM ❑DOG KENNEL ❑DAIRY W I (,�(.J <br /> LKHAZARDOUS WASTE GENERATO C� ❑CHICKEN RANCH ®WASTEWATER TREATMENT PLANT I_U ( <br /> TIERED PERMITTED FACILITY ❑MOTELMOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA <br /> ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY tKCOMPLAINT RECORDS ❑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 files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)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 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 released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to 1re^view. <br /> nN YI <br /> ('0004'10?_ I. Coco SS r p <br /> CtyU�i �SbZ l `'F1 n r Ck4 SMn dvs�, <br /> EHD 48-08 8/1/17 <br />