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oAr�npe=r. 23 u 2008 i H3AM 9�'-'•�anced GeoEnv i ronmental k�� No. 1830EHoE' JAUmsER <br /> SAN JOAQUIN COUNTY JL4- <br /> IL��f� l��l UVJ l IU� <br /> U �— ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 .East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgoy.org/ehd <br /> Grp' •�-:;,�.,;,},. • } ��� , <br /> PUBLIC RECORDS _ <br /> ..-.�r -,•� r� �..;.,; RELEASE APPLICATION _ <br /> APPLICANT., a nel �" Y�'G L Zz1 BVSINESSIAGENCY: !` [ 6'z <br /> ADDRESS: r6�GiJ €7Gs�a _ <br /> PHONE(4): - -` s✓C� PHONE(2)' . -e Cl w'96 - — FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE- Time: <br /> (Please allow 10 business days from date of applicatlon Submittal-"Tentativa only-must be confirmed) <br /> ,Xr'CHECK BOX TO EXPEDITE REQU -$98.00 FE ( SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAY <br /> SIGNATURE OF APPLICANT DATE Z3 _U <br /> Electronic Information: ❑List❑ Map—Description. <br /> FILE ADDRESS EHq USE ONLY <br /> Street Al Street Name city ❑ Unit 1 <br /> 2. �' �" A ❑ unit 2 <br /> 3. <br /> 4. / unit 9 <br /> Gu SLI f7r c�ncc i,e 7 -. f 1 It <br /> C lel I fi r' 7� rry <br /> �. 'U `0 <br /> 6. k f1 <br /> 7. <br /> $. <br /> 9. Unit <br /> 10, <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 11 HOUSING ABATEMENT Ak-98 In wAsTE FACILITYIVEH_ICLE <br /> ❑OTHER CLEANUP SITE(NC'N-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> I"NDERGROUNDTANK(MONITORINeiREMOVAL) ❑ DOG KENNEL ❑DAIRY <br /> 4"AZA11OOUS WASTE GENERATOR I7 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> ❑TIERED PiRMITTEn FACILITY ❑MoTELIHOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND UsF.APPLICATION SITE$ <br /> ❑MEDICAL WAS're FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MoNDAY.FRIDAY 8:00 AM-5,QOPM - acLUDING HOLIDAY6. <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(ss). At least one file type MUST be selected. Fax to(209)464-0138 ormall to the address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the I•HD.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 hold 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 19 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHO 48-08 WEB 6IM007 <br />