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_ �]�f� �./ EtNSP111� I / lJV SAN JOAQUIN COUNTY <br /> 2e10 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> E ;tk is -NT HEAR0110phone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org ehd <br /> PE-RV T;SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Cory IIA BUSINESSIAGENCY: 5 ADDRESS: Z+I',u N _ <br /> � w ?i (� CITYISTATE/ZIP: CA 11-5PHONE(1): g0 b87. PHONE(2): FACSIMILE:Q 6 <br /> TENTATIVE"APPOINTMENT DATE: -/Ib Time: tf - o0 <br /> (Please allow 10 business days from date o application submittal-'TentatM only.must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE RE EST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 3 2v6 Ifs <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS END USE ONLY <br /> streets f�l 1 Stree�tt Nem. city unit <br /> At 2 <s5�i.1 ❑Un <br /> 1(V�Yr 3. ss tj y S—Ae- <br /> 4. t} Jc. D ` TIN I <br /> 5. <br /> 6 - nK4 <br /> T. <br /> 8• []Unit 5 <br /> 9. <br /> 10. <br /> UMt6 <br /> specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES I_ � <br /> ;,UNDERGROUND TANK(aU <br /> ,�ST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIUTYNEHICLE lWO <br /> E <br /> ER CLEANUP SDE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIREERGROUND TANK(MONITORINGIREMOVAL)(n ❑DOG KENNEL ❑DAIRYARDOUS WASTE GENERATOR CX, ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT (,'�//� <br /> El TIERED PERMITTED FACILnYN ElMOTELIHOTEL Ll PUMPER TRUCKNARDICHEMICAL TOR S <br /> ❑TATRXVBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION STIES <br /> ❑ MEDICAL WASTE FACILITY ❑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 tan addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At bast one file type MUST be selected. Fax to 1209)464-0139 or mall 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 END will notify the applicant If any END files exist An appointment for review will be confirmed approximately tan(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointment* <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by END 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 END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> S. If you need further assistance, please contact Diane Martinez,at(209)468-3425. <br /> END JUL ONLY <br /> W t .lam - - O <br /> P <br /> W O <br /> CIO�L-12a(1202-11 <br /> END aerie <br /> anrle8 <br /> L00/L000 XVA L0:60 OIOZ/9Z/EO <br />