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( 88/10/[011 F(3;Bid FAI - TREA0'ELL & ROLLO Lyjv"'- <br /> a, f 1 k <br /> 1 EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ' 0 ENVIRONMENTAL HEALTH DEPARTMENT <br /> RIM& <br /> 600 asf Main St. Stockton, CA 95202-3029ephone: (208) 468-3420 Fax: (209)464-0138 Web: www-sigov.arglel�dE4 <br /> PUBLIC RECORDS RELEASE APPLICATION) <br /> APPLICANT: p �' D-L 13USINESSIAGENCY: { t'9-0-& <br /> ADDRESS:.��5— Ate, chrn,pr't -.� t a0. CITIISTATEIZIP: 5 1NII <br /> PHONE(1): PHONE(2); FACSIMILE: <br /> TENTATIVFF'APPOINTMENT DATE: Time, I a.w. <br /> (Please aiiow 10 business days from data.of applicatlon submittal-'Tentative only-must be confirmed) I <br /> ❑CHI_CK BOX TO EXPEDITE fRI ST-S CASH OR CHECK ONLY)-RI=QUEST PROCESSED IN 3 6USINCSS DAYS i <br /> SIGNATURE OF APPLICANT DATE r 10" <br /> Electronic Information. ❑ List❑Map—Description: <br /> _ FILE ADDRESS rHp u5F aNrY <br /> Street 0 Street Name City ❑Unit 1 <br /> 2. _ Unit 2 i <br /> _3 I <br /> 4, Unit 3 <br /> 6. unit4 <br /> 7. <br /> ,. 8. ❑Unit 5 <br /> i <br /> f - <br /> 10. Unit <br /> I .. <br /> Specific Date Range of Information Requested- l rdm �_" 1 Q 5- to <br /> ENVIRONMENTAL-HEALTH DEPARTMENT FILES <br /> UZERCK TANK(UST)CLEANUP SITE(LOP) ❑Hou5iNG ABATEMENT LJ SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NoN-LOP) ❑FoDD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORLNGIREMOUAL) ❑Doc KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH. WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MoTELIHoTEL PUMPER TROCKlYARDICHEMICALTOILETS <br /> ❑TATTO01$00Y PIERCING ❑POOLlSPA LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WFI.-L AND SEP-=PERMIT RECORDS ARE AVAILA8LE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:0012M(Exct UDING HOLIDAY$) <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 prn 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 far 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 /> 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 stung applicant may require a$122 deposit prior to review. <br /> END LISS ONLY <br /> EHD 48-06 07129110 <br />