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II / zD / zUVa la : � r rax f�j001 / 001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone : (209) 468-3420 Fax : (209) 464-0138 Web : www. Sjgov.org/e3 / """✓✓✓/// <br /> G <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINE99/ACExb <br /> ADDRESS: - '' Chy/Statol2lp <br /> PHONE (1); <br /> // <br /> ryBQ_Q;(R6 ! ] PHONE (2): � 01 FACSIMILE: A <br /> TENTATIVE" APPOINTMENT DATE: Time: I IIL1 <br /> (PlaRea allow 10 business days from data of application submidul - 'Tentrdve only - must be conarmad) <br /> ❑ CHECK BOX TO EXPEDITE RE T $,,,��Uyyyppl5 FEE (CAS,H_.O.{$ CH� ECK/O�NLY) - REQUEST PROCESaED IN 3 BUSINESS AYS <br /> SIGNATURE OF APPLICANT <br /> cs DATE ' <br /> Electronic Information : ❑ List [] Map — Description : <br /> FILE ADDRESS EHD USE ONLY <br /> Streetppq 9StreinttNomeC � CicityL�- <br /> z' <br /> a1 <br /> 4. �1�t5 N . EI sola_ Sl Unit <br /> s. N . n ,�, F Unit <br /> z <br /> 81 u s <br /> 8. <br /> 10, Unit e <br /> Speciflc Date Range of Information Requested: From to L( t LI P92± <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGNCI TANK (UST) CLEANUP SITE (LOP) HOUSING ABATEMENT SOLID WAsm FACILIW/VEHICLE <br /> OTHER CLEANUP SITE (NON-LOP) FDOD FACILITY WASTE TIRE <br /> UNDEROROUND TANK (MONITORINarREMOVAL) DOGKENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MomLIHOTEL PUMPER TRUCKrVARnjCHEM TOILETS <br /> TATTOO/BODY PIERCING DOLISPA -T"n D USE APPLICATION SITES <br /> MEDICAL WA5TE FACILITY OTHER (PLEASE SPECIFY) All TI S <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVaq.ABLE FOR REVIEW - MONDAY.FRIDAY 8:00 Am,0:00PM - EXCLUDING HOLIDAYS <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) 484-0138 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 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 be confirmed approximately ten (10) <br /> days after receipt of applioation , The flea will be held fora 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 /> 4. Any Ilia 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 /> END 4546 8104108 PUBLIC RECORDS RELEASE APP FORM <br />