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t _ i..^1 tHU WG NUMbtt.< <br /> y r r I ,;, .- I;J'j SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT 'S <br /> 600 East Main St. Stockton, CA 95202-30 9 `3 <br /> �;. <br /> Tele hone: (209) 468-3420 Fax: (209) 464-0138 Web: wvii►N. rg/eh <br /> r PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 14D -e- BUSINESSIAGENCY: 1= <br /> ADDRESS: 352 L)e, 5�C 2.O0 CITYISTATpE/IZIP: <br /> 6'1,0-9 <br /> PHONE(1): (D 3- PHONE(2): 51 0-�o�5-(P 2(0 FACSIMILE:S 1 Q-2clj - 2(P 5(p <br /> TENTATIVE*APPOINTMENT DATE: r( , rum 2 ZG 1 O Time: B/A <br /> (Please allow 10 business days from date of applicatl submi "Te tative only-must be confirmed) <br /> CHECK BOX TO EXPEDIT -QUE -$115 F H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUINESS/IDAYS <br /> SIG TURE OF APPLICA DATE / _ <br /> Electronic Information: List N Map-baicriptn: �ro~v\e J v� <br /> FILE ADDRESS_ .,5 is EHD USE ONLY <br /> Street# Street Name city _Unit 1 <br /> ;moo <br /> �(✓ 2. )� l l�l1 2d_ -__ - Unit2 <br /> 3. W <br /> 4. (� _ aCl` �1 I � 9Unit 3 <br /> 6. —2 ( W . M A.I n S Unit <br /> 8. 22_'7D (+w- 9qU Units <br /> 9. '2 �� i►n ' N°/� <br /> 10. 10 (o 2•n CO �J1' Unit 6 <br /> Specific Date Range of Information Requested: From P Q Y- <br /> ENVIRONMENTAL REALTH DEPARTMENT FILES <br /> ,UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br /> FLoTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE !�Cf <br /> 'MNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR d ❑CHICKEN RANCHASTEWATER TREATMENT PLANT I �U <br /> TIERED PERMITTED FACILITY ❑MOTEL/HOTEL PUMPER TRUCKIYARDICHEMICAL TOILET <br /> ❑TATTo01BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES",111 <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 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 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 application may be <br /> submitted when the file is available. �J( <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 /> E ONLY <br /> to (0- - 9 5_ t�1 �1 Ale-, <br /> M u •WOOD 51 - (V 16 S <br /> EHD 48-06)I'6 oo "C r f4y n /1W&I, <br /> �r ��19s�4 i/1`U7J�I� <br />