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JUI Uo u/ 1111da Apex 209 667-9668 <br /> • p.1 <br /> L DAT� 0 <br /> SANJOAQUIIV COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-27 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.( 0J <br /> {� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: QA 'N kA BUSINESS/AGENCY: �1t-1ex <br /> ADDRESS: 34 LI (n N, (1'o ltd-P.n Sk-o." S',�IJ..t C T.]v1,9 UC d+ Z- <br /> PHONE11): '701 (SID *-I PHONE(2)• 2-0't Cod tP1—Z'9-SZ- .7q CoGo�— 9ro(oi9 <br /> IrFACSIfdILE: � <br /> TENTATIVE'APPOINTMENTOATE:_ i7c O-1- Time: 6900 <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> _ FILE ADDRESS EHD USE ONLY _ <br /> Street# StreetName City / ❑ Unit <br /> 1. 8ll S S. tl boFkeA � is V <br /> 2. 139 � fel, l��S� o ct5 (rodi $021 ❑ Unit <br /> 3. 'SSSS GI. 1�QNv + tr Lomat S�Ck�n <br /> 4 0Z I�ctr�tA (JJa � A ❑ Unit3 <br /> s. zzzY Ma���t k Od <br /> 6. y �0� G t J a�C t Lo a Kcu, c� Sf�c k M� ✓ Unit <br /> 7. - -- <br /> $ ❑ Unit 5 <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of information Requested:From to Zoa7- <br /> �/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Int UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> C3 OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑WASTE TRE <br /> 0 UNDERGROUND TANK(MONITORINGlRmovAL) ❑ DOG KENNEL ❑ DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> El TIERED PERMITTED FACILITY ❑MOTELHOTEL ❑PUMPER TRUCKIYARD/CHEM TOILETS <br /> 0 TATTOO/BODY PIERCING ❑POOLISPA ❑ 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-5:00PM - 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 t2D9)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 rive 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD4806 6/JW1 <br />