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�� v:ri Ori �vvo �vL ,.v: we reLA 10441/441 <br /> DATE RECEIVED EHO LOG NUMBER <br /> SAN JoAQUiN COUNTY <br /> F ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95242-3029 <br /> Telephone: (209)468-3420 Fax (209)464-0138 Web: wvuw.sjgov.Org/ <br /> PUBLIC RECORDS RELEASE APPLICATION <br />' APPLICANT: I e— L 6c r_Vka r+ BUSINE=SSIAGENCY: t7 S IC S SC)C 1'a,e <br /> ADDRESS: JeJ I f< [ Q 0rl tf #.l CQ I�L�/b��IC C. M .. r LP '7 Ci <br /> PHONE(1): ((f ' S 2 PHONE(z); • FACSIMILE: <br /> -Lt4.I TENTATIVE*APPaINTMENT DATE:_ f-5 f U Time_ . <br /> (Please allow ten business days from date of apprcaGvn submittal-'Tentaflvc only-must be con mad) <br /> E3 CHECK E3OX TO EXPEDITE REQUEST-SS93. CA$H OR CHE Y)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _- ICC -��`—' — ._ UATE <br /> Electronic information: List❑Map-Description: P�Z /Z a u r'tA S AA 64 y4 <br /> i <br /> FILE ADDRESS END USE ONLY <br /> Sleet# 5trectName _ City pue,t <br /> 2. �� II rc r1�376 ie�"/JT . C7Unit z <br />` 3- 3U( 0 '4 Trac q S <br /> —309 "6o L <br /> 4. L4,5­0 TG ('. t Tr` C el J x.40 A,6_Lnit a <br /> s. 5 1-ho W UrA vt-f ;rL2.2oap( rrrz a c L) . <br /> 6. 553 d <br />( 2 3" sf c 2 7�r c I4 SS 7 n <br /> f ._.. �,.r� � 5a� q Ita <br /> 7. <br /> L ca vi f fi r' 2a 7-ratCFS3 <br /> 8. 3 0 CGtVt#- 1!'�R . If'OCcG� TrafZ� o�5QS ou�,its <br /> 9• ;,_e_ r�Dad. T�rce 4S3Cay <br /> 10. nit 6 <br /> 0000, <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUPSITE(LOP) D HOUSING ADATEMENT r;TSOLID WASTE FACILrrYivEMICLE <br /> }�OTHER CLEANUP SITE(NON-LOP) El FOOD FACILITY XrWASTE TIRE <br /> f�UNDERGROUND TANK(MON76RINGIREMOVAL) to DOG KENNEL Ea DAIRY <br /> f HAZARDOUS WASTE GENERATOR El CHICKEN RANCH O WASTEWATER TREATMEN'T PLANT <br /> TIERED PERMrrTED FACILITY` ❑MOTELIHOTEL C3 PUMPER TRUCKIYARDICHEM TOILL'TS <br /> _ ❑TATToDIBDDY P[ERCING 13 PooilSPA O LAND USE APPLICAnON srTES' <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br />+ WELL AND SEPTIC PERMIT RECORDS ARE AVAILAkE PORREVIEW-MONDAY-FR[OAY$:DO AM-S:OQPM - EXCLUDING HOLIDAYS. <br /> t i. Ust up to ten addresses in the space above. Select the type(s)of files from the fist above by checking the appropriate <br /> s box(es). At least one file type MUST be selected, Fax td.(209)464.0138 or mail,to the above address. Address ranges will <br /> not be accepted-for additional assistance With file addresses,contact the EHE). Applications received after 3:00 pm will <br /> be processed the neat business day. <br /> 2. The EHD will notify the applicant if any EHD files exist.,An appointment for review will be confirmed approximately ten <br /> days after receipt of appllcation. The files will be held for a maximum of five business days for revlew. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being wgrked on by the EHD staff may not be immediately available for review. A new application <br /> may be submitted when the file is available, <br /> 4, Any file not returned In the same Condition as released will be reorganized by EHD staff aithe 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 /> t <br /> F.1404846 10l23h37 <br /> i PUBLIC Rf:CORDS RELEASE APP FORM <br /> i <br />