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"uY wEU LU.' 05 FAX 2.094682999_530 Pub-1-zc works <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> FEB €' 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> ,•, �Trrlephone:{209)468-3420 Fax:{209)464-0'!38 Web:www.sjgay.org <br /> PtJl.��SEI'iCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: -- 1 <br /> .,_ BU IA <br /> ADDRESS: -do t, Ia 7— Av City!$tateizip 5-1pS GP 111i <br /> PHONE(1): _�O9 �/( — PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: 1 <br /> {Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE RE T-$1 FEE kCHECK ONLY)-RE4UEST PROCESSED <br /> �IN}3 BUSlNE55 DAYS <br /> SIGNATURE OF APPLICANT �^ DATE d� <br /> Electronic Information: <br /> ❑List[]Map—Description:_ I <br /> FILE ADDRESS EHD USE ONLY <br /> Streal# street Name City /'U'r <br /> V <br /> �l2aDl aK-t ST rac <br /> � 1. it 1 � <br /> l 2- 3 (� a%,%,,t'L 5 enc 1 r'o.c o29(P a unit 2 <br /> [ m <br /> � 3. Gora.K t- L+.n>` yet { a.ac J <br /> 4• 0. car *C+� i 6. <br /> nit 3 <br /> N. <br /> 7. <br /> Utiit4,. <br /> IVi F. Unit 6 <br /> 0�.'. 1. A>E�.i. r .Ir <br /> ,)0. © unit s <br /> L Fir <br /> Specific Date Range of InfOrMation Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> OLUNDERGROUNDTANK(UST)CLEANUP SITE(LOP) AI-Ious=ABATEMENT 0SOLID WASTE FACILTTYIVEHICLE <br /> OTHERCLEANUP SITE(NoN-LOP) JEFfOOD FACILITY d WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) - 13 DOG KENNEL - ©DAIRYLK�H - <br /> AZARDOUS WASTE.GENERATOR 1 13CHICKENRANCH O WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY �MOTELIHOTEL 13 PUMPER TRUCKIYARD�ICHEM TOILETS <br /> C1 TATro01BODY PIERCING t�POOtISPA O LAND USE APPLICATION SITES ' <br /> 13 MEDICAL WASTE FAciuTy d OTHER+PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA9LEFon REVIEW-MONDAY-FRIDAY 8:00 AM-5:00PM -EXCLUDINGHOLIDAY& " - <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 /> 3:04 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 W confirmed approximately ten J1 0) <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 available. . <br /> i 4. Any file not returned in the same condition as released will be reorganized by EH.D staff at the expense of the applicant. <br /> } Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8104/08 i <br /> PUBLIC RECORDS RELEASE APP FORM <br /> { <br /> J <br />