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0'I-19-0 q; 11 :4SAM; <br /> mn <br /> .. <br /> i Lu) SAN .10AQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> '44N 2 () 2005 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: WWW.Sjgov. <br /> Et4VIRt�id�ME,��i HEALTH <br /> q0 57 <br /> PERtdlI_US ERVCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: _SaroA\ KOvroSe_ BUSINESS/AGENCY: _ OR S <br /> ADDRESS: aKS'-b<. City/State/Zip GY arapv 4 0 _ Cie, 9 S E33 <br /> PHONE(1): a1U- (a-1c1-a 35 PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: 0, 1 B.1001 Time: ol'O(7 o_v, <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST.$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE __ II"-9 <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Streett## Street Name City <br /> 1. g(ot1 S i it ❑ Unit 1 <br /> 2. 551 `/V ❑ Unit2 <br /> 3- <br /> 4- a Unit 3 <br /> 5. a b a�1a� _ D <br /> 6, abqq Unit4 <br /> 7. a 'too <br /> 18. aZ b q1 ❑ Unit 5 <br /> 9• <br /> 10. 3 ❑ Unit 6 <br /> Specific Date Range of Information Requested:From 10130 to Drese-tk <br /> �,,,,�/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> /UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C1 HOUSING ABATEMENT 0 SOLID WASTE FACILrrYNEHICLE <br /> VTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) O DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 177 MOTEL/HOTEL M PUMPER TRUCKIYARDICHEMTOILETS <br /> 0 TATTOO/BODY PIERCING 0 POOL/SPA 0 LAND USE APPLICATION SITES <br /> 0 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 ten addresses in the space above. Select the type(s)of files from the list above b checking the appropriate <br /> box(es). At least one file Y gabove. <br /> A <br /> 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />