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May 31 07 08: 55a Gln Aro 530-11-0827 P. 1 <br /> DATE RECEIVED <br /> l{QU 1 SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> D)�� 304 East Weber Avenue, 3'd Floor, Stockton, CA 95202-2708 <br /> elephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ <br /> ONehd <br /> PUBLIC RECORDS RELEASE APPLICAT <br /> I <br /> APPLICANT: 7LEA/I}AI ar) BUSINESS/AGENCY: LG <br /> ADDRESS: I/ <br /> PHONE(1): S30 320-9wa PHONE(2): "D�Z FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE Time'— <br /> (Please <br /> allow 10 business da om date of application submittal-•Tenratfve only-must be con Irmed) <br /> Ix CHECK BOX TO EXPEDITE RE UEST $95.00 E AS CHECK ONLY)-REQUEST PROCESSED IN 3 B SIN SS DAYS <br /> SIGNATURE OF APPLICAN DATE 31 p <br /> Electronic Information: ❑List EIMap-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑ Unit 1 <br /> 1. /2 . /fir �. <br /> 2. lD , Lo Pz </ 2c/(P5 ❑.Unit <br /> 3. ZLOAM- <br /> 4. <br /> Unit 3 <br /> 5. <br /> 6. ,PFUnit 4 <br /> 7. <br /> 8 ❑ unit s <br /> 9 <br /> 10. tit ❑ Unit 6 <br /> Specific Date Range of Information Requested:From to <br /> 4UNDERGRMNb <br /> ENVIRONMENTHEALTH DEPARTMENT FILES <br /> TANK(UST)CLEANUP SITE(LOP) 13HOUSING ABATEMENT 13LI <br /> SOD WASTE FACIUTYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 13 DOG KENNEL 13 DAIRY <br /> OTHER <br /> GENERATOR Cl CHICKEN RANCH 0 WASTEWATER TREATMENT PLAN <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPERTRUCIGYARDICHEMTOILETS <br /> TATTOOIBODY PIERCING 11 POOL/SPA 0 LAND USE APPLICATION Sacs <br /> 10 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ME 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(209)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 END 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 END 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 END 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 /> END USE ONLY <br /> EHD484G 9IM006 <br />