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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjg 4MI40 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 2/C04RO N Lh"O BUSINESS/AGENCY: eN Gt;U <br /> ADDRESS: 0 W,'jMP 7T <br /> City/State/Zip IIC i A-'49s�rn _ <br /> PHONE(1): 2G4- - 6(!jQ PHONE(2): '2b61 I <br /> FACSIMILyE <br /> TENTATIVI_*APPOINTMENT DATE: l Z- 0 7 Q p <br /> Time: :50 <br /> (Please allow 10 business days from date a plication submittal.*Tentative only-must be confirmed) <br /> ❑ CHECK 13OX TO EXPEDITE REQU $105 F C HO ECK ONLY)-REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE - /----1 ZQ� <br /> Electronic Information: ❑ List❑Map Desorlption: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. R C"t U ch f. 1�° 1 ❑ Unit 1 <br /> 2' ` v SOC :��. mt:? 11 Unit 2 <br /> 4. 2 D S s-FnCLt+o , A1►G Sd£f e D Unit 3 <br /> 5. 1 S- ctr e, �� 3 <br /> g, 4 E a8 ✓ ?FUnR4 <br /> 7. 3 l r <br /> S- 3,5.2 <br /> 8• 33} 14 14 ❑ Unit 5 <br /> j 5,,-2W' <br /> 10. 23 0 Unit6 <br /> Q 4Ll sorra I Ae— CJ <br /> Specific Date Range of Information Requested:From to Pf S C/LrG <br /> 1 ]ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ../,�.I{-UNDEROROUND TANK(UST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT 0 SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) t3 FOOD FAciuTY 0 WASTE TIRE <br /> Til UNDERGROUND TANK(MONITORINGIREMOVAL) 0 Doo KENNEL 0 DAIRY <br /> , -HAZARDOUS WASTE GENERATOR 1O CHICKEN RANCH C3 WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITYED FACILITY 0 IMQTEL/HOYEL ©PUMPER TRUCK/YARDICHEM TOILETS <br /> ty TATTOO/BODY PIERCING 17 POOUSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASYE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-PRIDAY 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 appliciption. 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 49-06 a/04/08 PUBLIC RECORDS RELEASE APP FORM <br /> TO 30Vd NOdI�1035N3 96LT6696OZ Tb :TT 8002/LT/ZT <br />