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M 0 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT (//�/� ' / <br /> 600 East Main Street, Stockton, CA 95202-3029 �p�//�V (� S <br /> Telephone: (209) 468-3420 Fax; (209) 464-0138 Web: www.sjg h 7 <br /> ^PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �rCf(1f(l� N Lf=O BUSINESS/AGENCY: eN3tU <br /> ADDRESS: _ 58O N W IM AV, Chy1$tatel2ip �),� OIL, 9S'i(n� <br /> PHONE(,): 2r,4-°�Q6,Fq--160il PHONE(2): Z0_ 4 31-1, 2bbS" FACSIMILLE: lu-.7�9 a69� <br /> TENTATIVE*APPOINTMENT DATE: (Z-1C'-00 Time: O • C <br /> (Please avow 10 business days from data a plication submittal-"Tentative only-must be confirmed) <br /> ❑ CHECI<BOX TO EXPEDITE REQU 6 $105 F "HOECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 41 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> Unit 1� S'tU vh f, 1r'• 1 D ❑ <br /> 2. 1 I U 4k .SOC .S'�. ,f}Ve? ❑ Unit2 <br /> 3. econ <br /> t a =� . <br /> 4' 2 0 S J I'Ocbt+o' �7�L- a C Unit 8 <br /> 5. 1 Mai, <br /> Unit4 <br /> 0011 <br /> 7 31 S . 3Sr 2 ❑ Unit 5 <br /> 8. Zip 33 <br /> 9- L s s a� ❑ UnIt6 <br /> 10. Z3 0 dL.[S-{rr'a AVc. <br /> Specific Date Range of Information Requested:From _ aPe b21} to 121-ci rLk <br /> ,,J�/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> /sl-UNDEROROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> XoTNER CLEANUP SITE(NON-LOP) ❑FOOD FACILRY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL d DAIRY <br /> 0—HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> IM TIERED PERMITTED FACILITY ❑MOTELIHOTEL C3 PUMPER TRUCKIYARDICHEM TOILETS <br /> C'TATTOOISODY PIERCING ❑POOLJSPA ❑ LAND USE APPLICATION SITES <br /> EJ MEDICAL WASTE FACILITY ©OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 6:00 AM4:00PM - EXCLUDING HOLIDAYS <br /> 1. List up to ton 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 mall 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 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 he 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 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 EHD 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 46.06 a7 mos PUBLIC RECORDS RELFASE APP FORM <br /> TO 3DVd NOdIJ039N3 56LT66569Z Tb:11 890E/LT/ZT <br />