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DATE RECEIVED , <br /> SAN JOAQUIN COUNTY E ) EHD LOG NunnaER <br /> �i: _f <br /> ENVIRONMENTAL-, HEALTH DEPARTMENT <br /> 600 fast Main Street,'Stockton, CA 95202-3029 33 <br /> Telephone,. (209)468-3420 Fax: (209)464-0138 Web: WWW.sjgov. 43d <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �G ( BUSINESS/AGENCY; <br /> ADDRESS: �D ��� GGoTr�,1nlCr ► IG, <br /> � ('- r"r-, � Citylstatelzip_ 1 nnlC n'-,.? <br /> PHONE(1): (91(p)`ZC,`-�- + ItcjPHONI (2}: ��t(r� VF, 3 l�C z2 FAC51M1 f w}85 ;--J�rc�C� <br /> TENTATIVE,*APPOINTMENT DATE: c,` Time: r'+ <br /> VI <br /> (PleaSe aIIGW 10 business days from date¢f application sbmitlal-'TenfatJve only-must be cantlmted) <br /> © CHECK BOX TO ExPEDiTt+RROUEST-$105 FEE(CASK R CHE K ONLY)-REQUEST PROCESSED IN 3 BUSINESS GAYS <br /> SIGNATURE OF APPLICANT <br /> i <br /> DAVE <br /> Electronic Information: ❑ List] Map—description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street-Name City - <br /> �. <br /> I`4it © un It 1 <br /> 2. CI unit2 <br /> 3. <br /> jt" IV <br /> 4• ZqOd �� Z< d2�f7.JZ>� 7YL� 1~-- r rr <br /> 6. unit 4 <br /> 7. <br /> $• d Unit 5 <br /> 9. _ <br /> 10, - unit 6 <br /> Specific Date Range of Information Requested: F.ram 0�� _"R - <br />'r to <br />' ,..(! ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M - — <br /> 'UNaMGROUND TANK(UST)CLEANUP SITE(LOP) C1 HO LIVING ABATEMENT <br /> 0JOTHER CLEANUP SITE(NON-LDP) 0 Fo4D FACILITY 0 AST WAsti:FgcItITYNEMIcLE <br /> ebNDERGROVND TANK(MONITORINW11cMOVAL) 171 Doo KENNEL WA5TE Tlks <br /> »HAZARDOUS WA$TB GENERATOR 0 DAIRY <br /> 0 TIERED PERMnTto FACILITY ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> CITATTCOIBODY PIERCING i3 MOTC)PUMPER TRUCKIYARD/CHEM TOILETS <br /> 0 MEDICAL WASTE FACILITY Q-PoaUSPATEL SPA ©LAND WE APPLICATION SITES <br /> C3 OTHER(PLEASE SPECIFY} <br /> WELL AND SEPTIC PERMIT RECORbg ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM,5:00PM - EXCLUf71NG HOLIDAYS. <br /> 1, List up to ten addresses in the space above. Select the <br /> box(es). At least one file type MUST be selected. F t"'201464-1or mals frOM e loth a dress(dicatist above by edh bave�oAddress <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 a <br /> days after receipt of application. The files will beheld for a maximum of five business days for review• l <br /> Appointments(t01 <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 now application may bo <br /> .submitted when the file i&avallable. <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$145 deposit prior to review. <br /> END USE ONLY <br /> EHD 4$-06 810410. <br />