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blit 15/ 2UI7 I 14: 53 <br />UllM9 M 11 E10 <br />2007 <br />ENVIf4I.;N'9ENT HEALTH <br />PFR;,, iIT/SERVICES <br />APPLICANT: !C, <br />2133800505 <br />ENVIRONMENTAL <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMEN <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 9520- 8� <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sj v. <br />PUBLIC RECORDS RELEASE APPLICA ON <br />ADDRESS: 515 L"VI <br />PAGE 01/01 <br />EHD LOG NUMBER <br />692 <br />BUSINESS/AGENCY: <br />5, Z_A <br />PHONE (1): PHONE (2): r7, (3' �'?i X216 FACSIMILE:�— QS <br />TENTATIVE" APPOINTMENT DATE: .. Time: 0 D <br />(Please allow 10 business days from date of application submittal-'TenraNve only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - 0 SH 0 K ONLY) -REQUEST PROCESSED IN 3 BUSINESS DgY9 <br />SIGNATURE OF APPLICANT DATE <br />Electronic Information: LJ List L j Map — De5criptlon: <br />FILE ADDRESS <br />EMD USE ONLY <br />Street# <br />Street Name <br />city <br />A5 -T(6 (� i G,,, ❑ Unit <br />2. <br />❑ Unit2 <br />3. <br />4. <br />Unit 3 <br />5. <br />Unit 4 <br />6. <br />— <br />T. <br />❑ Unit s <br />8 <br />9. <br />El unit a <br />10. <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />'Q�UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WA5TE FACILITYNEHICLE <br />❑ OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br />.P:1)NDERGROUND TANK (MONITORING/REMOVAL) 13DOG KENNEL ❑ DAIRY <br />'.r <br />—o-gAZARD0US WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />El TIERED PERMITTED FACILITY ❑ MOTELIHOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOO/BODY PIERCING ❑ POOL/SPA LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILAELF FOR REVIEW - MONDAY -FRIDAY 8!00 AM-6;00PM - EXCLUDING HQLIPAYS. <br />1- List up to Can addre99es in the space above. Select the type($) 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 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 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 appllcation 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 raquire a $95.00 deposit prior to review. <br />EHD USE ONLY <br />END 4MG 9113/2063 <br />