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11/6V1LVVZj 1D:zb ban Joaquin County —> 4640138 2 <br /> Z. <br /> �! T i -- !, -,L--:]D JOAQUIN COUNTY EHD LOG NUMBER <br /> tvtJ " 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St.Stockton, CA 95202-3029 <br /> ENVIRONIVINT HEALTT?Iephone: (209)468-3420 Fax: (209)464.0138 Web:www.�gov.org/e <br /> f'��iY'ii/`�EP,�'��ES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: As�,�- ��� <br /> ADDRESS: 44- N �7Nn�reAl CITY/STATE/ZIP: ���S,xroni CA 95 0 <br /> PHONE(1): (AUK) 4��,- azo f3 PHONE(2): FACSIMILE: 01,,r) q44-9 5/S <br /> TENTAT/VE'APPOINTMENT DATE: Dc-c ¢ • 2Uoq Time:__ /p:,, <br /> (Please allow 10 business days from ditto of application submltta(-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQI ISSTT�-$116 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �(!/ lL�sc C� DATE_Nov t q, ayo y <br /> Electronic information: [I List(]Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street R Street Name A PN City Unit 1 /I <br /> 1. a705 Coy R Cr-L - Io- Sroc:Kron/ `Jo'Z�O <br /> 2. .213 Ae, osA AD. 173•o(,o•,j u (]Unit2 \ <br /> 3. P++S W. Karri-emAo,4 LN o+s-t50-11 Loot <br /> 4. /39Z5 91 w 011,026-4 I.oc. e-optoto <br /> 6- 3s N. HG. K f LN •o Loo <br /> 6' -140-11 LODI ,{ <br /> 7. <br /> B, <br /> 9 O Unit b <br /> :Lj 10. <br /> ❑Unit 8 <br /> Specific Data Range of Information Requested: From l I I/a000 to <br /> ENVIRONMENTAC HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIIRYNENCLE <br /> ®OTHER CLEANUP SITE(NO*LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ® <br /> UNDERGROUND TANK(MOMTORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH []WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FAcx iTY ❑MOTELMOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATTOO/BODY PIERCING ❑POOL1SPA ❑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-6:00PM(EXCLUDING HOLIDAYS) <br /> I. 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(2081464.0138 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 behold 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 some applicant may require a$116 deposit prior to review. <br /> 6. If you need further assistance,please contact Diane Martinez,at(209)468.3426, <br /> EHD US6 ONLY <br /> t:Ho Baa <br /> armos <br />