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UNI L <br /> SAN JOAQUIN COUNTY �. I <br /> - ENVIRONMENTAL HEALTH DEPARTMENT ' <br /> 4-41 9 VIG 600 East Main St. Stockton, GA 95202-3029 <br /> N��RUNI ENT HKT� H Telephone: (209)468-3420 Fax: (209)464-0138 Web; WWW.SjgoV.or /ec eh <br /> pE-FUT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: OL.lv+-R '(Ar- BUSINESS/AGENCY: CoN�ToCaA- leoVVnS li, ASSoctp,-;;�j <br /> ADDRESS: lOgkct —['2AgP- ceNrie)?- DQlyti St/ITt ICF CITY/STATE/ZIP: 9i!%Gr{o (1 L700t/41, CA <br /> PHONE(1): ILIII(a)8` 9-'Pq2a PHONE (2): FACSIMILE; N(0)g439--819-1 <br /> TENTATIVE"APPOINTMENT DATE: 10-t3—Id (p• Time: <br /> (Please allow 10 business days from application submittal-"Tentativee o y-must be confirmed) mm <br /> © CHECK BOX TO EXPEDITE REQUEST- 1,22 . E(CA H OR H CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT' DATE <br /> Electronic Information: ❑ List❑ Map— criptl <br /> FILE ADDRESS EHD USE ONLY <br /> -.......... . <br /> Street# Street Name City ❑Unit 1 <br /> t uZ SoKZN Rp�ea L�4TH2oP "� lu—cJG 57 <br /> 2. 13-43a �ouT +41 2 rt+IRoP hk+�TECaElUnit2 <br /> 3. f;40rcKTt2 S PR-eAA S?E�� � ---i,Tiw wY - ';Z.,AIR 2Y WA,YA ,14. r IV <br /> Unit 3 <br /> 5. <br /> Unit 4 <br /> 7. <br /> _ I L ©Unit 5 <br /> 9. <br /> 10. <br /> El unit B <br /> Specific Date Range of Information Requested-- From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> LI UNDERGROUND TANK(UST)CLEANUP SITE(LAP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> ®,OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ©UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRuGWYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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 209 464-0138 or mail to the add[2gis 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 application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by EHO 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$122 deposit prior to review. <br /> EHD USE ONLY <br /> FNf1 Q1111� �••,, <br /> O7f9Gf9(1 <br />