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DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, 38 Web: ww. 0 soft <br /> Tolephone: (209) 468.3420 Fax: (209)464-0138 Web: www.sjg h <br /> ^PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: kF(C'wo L.SRNT)ALhO <br /> ADDRESS: _ S80 nI WIIn1 )Ql� BUSINESSIAGENCY: �N �♦`U <br /> city/state/zip <br /> PHONE(t); 2Ga- 6 -�6�Q IQ Cam—^� <br /> PHONE(2): Z04 3 2( Z 6 b S FACSIMILE: -'2 <br /> TENTATIVE*APppINTMENi DATE: (Z' 6-Q <br /> (Please allow 10 business days from data a plication , Time: 0 30 <br /> P bubmittal- Tenrat/va only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REgU $703 F C <br /> H O ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE Z l?--O <br /> Electronic Informat11 ion: (] List❑Map-Dascrlpti0n: <br /> FILE ADDRESS <br /> Street# Street Name <br /> 1. "l City EHD USE ONLY <br /> Ave <br /> 3. Q ❑ Unit 2 <br /> 4. 2 o S. s�nCLctu q,� <br /> Units <br /> B' 34 E 8' ✓ unite <br /> S 33} f� `� ✓ ❑ Unit 5 <br /> S <br /> 10. 2'Ja� [] <br /> p �' dL/.S-�rra l ,qte. � unit <br /> Specific Date Range of Information Requested:From EPr 1121 <br /> to pres-en,>c <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) <br /> 0 ❑HOUSING ABATEMENT <br /> �1 OTHER CLEANUP SITE(NON-LOP 0 SOLID WASTE FACILITY/VEHICLE <br /> W UNDERGROUND TANK(MONITORING/REMOVAL) O FOOD FACILITY C3WASTE TIRE <br /> •`j,HAZARDOUS WASTE GENERATOR DOG KENNEL 0 DAIRY <br /> 0 TIERED PERMITTED FACILITY 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> •TATTOO/BODY PIERCING 0iMOTEIHoTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> •MEDICAL WASTE FACILITY CO POOLISPA 0 LANG USE APPUCAYION SITES <br /> 0 OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARF AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM.b;OoPM -EXCLUDING HOLIDAYS. <br /> I. List Up to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2wi 454.0138 or mail to the address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with Elle <br /> 3:00 pm will be processed the next business day, addresses,eontactthe EHD. Applications received after <br /> 2. The EHD will notify the applicant If any EHD flies exist. An appointment for review will he confirmed approximately ten (10) <br /> days after receipt of appilcption. The flies will be held for a maximum of five business days for review. Appointments <br /> should he 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 EHO 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 4e-09 8/04100 <br /> PUBLIC RECORDS RELEASE APP FORM <br /> TO 39Vd NOdIa039N3 96L T6656OZ Tb :TT Rc1a7u T nT <br />