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DATE RECEIVED EHD LOG NUIVtBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304ast Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> 'relepho e: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUT LIC RECORDS RELEASE APPLICATION <br /> APPLICANT: YA11(d D)066?-�4 BUSINESSIAGENCY: A1C lir��Yl1?ei717C1 <br /> ADDRESS: ,✓o?RS More 1/o jalmratifJ <br /> PHONE(1): A75- -&Ca --{7 fd '-/ PHONE(2): 9�5'- ��Sd --7-?3,� lee/! FACSIMILE: �';75 -¢o,;2 <br /> TENTATIVE*APPOIN MENT DATE: J/—;oo f Time: /0*t� <br /> (Please allow 10 business days from 4ate of aplAication submittal-`rentative only-must be conflrmed) <br /> ❑ CHECK BOX TO EXPEDITE BEQUEST.$95.00 FEE(CASH OR CHI=CK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ���( Gt�. LL. I L `'J — CRATE u 6 <br /> e' <br /> Electronic Infonnation: L3 Lipt❑ Map–Description: <br /> FIL9 ADDRESS EHD USE ONLY <br /> Street Street Name City ❑ Unit 1 <br /> 2. 5,/5- W ( f t'LY W rCd d C/)- ❑ Unit 2 <br /> 3. 4 v 0 VV �' (tGY Wk J),�cLtm– Unit s <br /> 4. �f NI C Lr Ge C_�.fbvLr <br /> 5. 4)4/ 1^( k'r W&q, <br /> Unit 4 <br /> 6. I41b S S / .a "Na <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> Unit B <br /> Specific Date Range of Informationequesied: From to <br /> tNVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I'd UNDERGROUND TANK(UST)CLE=ANUP SITE(LAP) ❑HOUSING ABATEMENT —$OLID WASTE FACpJTYNEHIGLE <br /> OTHER CLEANUP SITE(NOWLOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMONAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WA$TEWATER TREATMENT PLANT <br /> ;,11TiERED PERMITTED FACILITY 13 MOTEL/HOYEL O PUMIPER TRUCKIYAROICHEM TOILETS <br /> ❑TATTOWBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> C3 MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPECIFY) <br /> WELL AND Sepmc PERmrr REE2RDs ARE AvAILA9LE FOR REYIEw - MONDAY-FRIDAY a:o0 AM-5:OOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ben 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)A64-0139 pr mail to the address indicated above. Address <br /> ranges will not be accepted–for additional assistance with rile 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 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 availab e. <br /> 4. Any file not returned in the same onditlon as released will be reorganized by EHD staff at the expense of the applicant, <br /> Future file reviews by the same a plicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EH048-06 E/13r2005 <br /> TO 39Vd Fd DNI�G3NION3 3I13 OZLVZ099ZGT Z0:60 990Z/ZT/ZT <br />