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SIV I I' EHD LOG NUMBER <br /> r, SAN JOAQUIN COUNTY <br /> x; <br /> ENVIRONMENTAL HEALTH DEPART ,_ <br /> „�..; :,j LU 16 600 East Main St. Stockton, CA 9520 <br /> i ephone: (209) 468-3420 Fax: (209) 464-0138 Web wvVw.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: � l .�� 2 BUSINESS/AGENCY: CIE- � �' 1 <br /> ADDRESS: 1'1�J. S+C 2� CITYISTATE ZIP: -USI �^ ��P 5 G� C kqZ(P Z <br /> PHONE(1): Cj O- lP '� PHONE FACSIMILE: 510-2_9/5- <br /> TENTATIVE*APPOINTMENT DATE: {-Y10k0. i 2- 2 0) U Time: Ry-'l <br /> (Please allow 10 business days from date of app ca ion sub 1- Tentative only-must be confirmed) <br /> HECK BOX TO EXPEDITE REQ T-$115 SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUST ESS D YS <br /> SIGNATURE OF APPLICA DATE ZS /0 <br /> Electronic Information: List XMap- scription: f�_ ✓y u' ✓1�` �e <br /> FILE ADDR j EHD USE ONLY <br /> Street# Street Name city -- -- .0 unit 1 <br /> s. 7- L O U`S �--, ��} coli <br /> S a ' _ ��,s Unit 2 <br /> 3. <6 <br /> 4L <br /> � I e� <br /> 4. ,1 � }� <br /> _ <br /> i�� l � Unit 3 <br /> _ _ <br /> 5. 3 3 <br /> 6. ZZ?j r�� 1/-1 ��✓l t�Z /��9 �1 --- — U nit11 <br /> 4 <br /> 7. 06 rcp/y <br /> 8• Unit5 <br /> 9. <br /> 10. XUnit6 <br /> Specific Date Range of Information Requested: From to r Pk�) <br /> NO ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT �SOLID WASTE FAC UTYNEHICLE � <br /> [�t6+ OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTETIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY I✓� ��y"�) <br /> AZARDOUS WASTE GENERATOR E]CHICKEN RANCH WASTEWATER TREATMENT PLANT Y <br /> IERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> av` ❑TATTOO/BODY PIERCING ❑POOLISPA <br /> LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 0,- 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)4640138 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$115 deposit prior to review. <br /> 5. If you need further assistance, please contact Diane Martinez,at(209)468-3425. <br /> END USE ONLY <br /> 34 IJ6— N, <br /> C' J i11 f <br /> EHD 46 <br /> a_ vU,t&. I-�'I.SIL <br />