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A CECM WED EHD LOG NUMBER <br /> llllll SAN JOAQUIN COUNTY <br /> �( ({ j 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 Et p R LAMENT HEA telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.oqzg5% <br /> 11 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 N a OI BUSINESS/AGENCY: E.iW3 O '/ <br /> ADDRESS: too�NI111 <br /> N. WI� p_ Auf- Jilt City/staterzip Kt� Ca q c3&4 <br /> PHONE(1): ZDq �tl —4(pCq PHONE(,21),I: V ;-Zt _ 2r�j' FACSIMILE: <br /> l <br /> TENTATIVE"APPOINTMENT DATE; AarCL. ri 7-00q Time: <br /> (Pleas®allow 10 business days from date of application Submittal-'Tentative only-mutt be confirmed) <br /> CHECK BOX TO EXPEDITE RE T- Of EE(CASH OR CHECK ONLY).REQUEST PROCESSED INS BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 4 DATEq-ZI-f? <br /> Electronic Information: ❑ List❑ Map-Description: <br /> l' FILE ADDRESS ._._ EHD USE ONLY <br /> --_l Street!! Street Name City Unit 1 <br /> 1. 4 0_4 C S-r S d — NqJ19 ljoci: <br /> 2. W. Osr-W M eco w/aES o sP units <br /> v 3 . MaoeAum Ail3 <br /> 4. Z-) 065jmo IDIhP Unk <br /> 041T UnIt4 �/ <br /> 6. 1A ... I U9 '� - UO(0�j('. <br /> 7. <br /> 8- LInit 5 <br /> g <br /> � ._ aaa o �a►y . � � 4�i <br /> 9. , nit6 <br /> 10. ap (� o S. i Uhi L �J'"ol��tJ <br /> Specific Date Range of Information Requested:From C-r IQ13- _ o rH OJ7 recy,+ <br /> .»r ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) <br /> C3 HOUSING ABATEMENT C3 SOLID WASTE FACILITYNEHICLE ✓� / <br /> XOTHER CLEANUP SITE(NON-LOP) M FOOD FACILITY ❑WASTE TIRE <br /> .K�tLI )- 0 0 NDEROROUND TANK(MONITORINtTIftEMOVALDoe KENNEL DAIRY <br /> ; I �hI <br /> K.H13AZARDOUS WASTE GENERATOR VV�� CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 13 PUMPER TRUCKIYARC/CHEM TOILETS <br /> ❑TATTOO/ ocrr PIERCING ❑POOUSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 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 len 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)454-0138 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 Tiles exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will behold 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 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 /> 4- S a � k!� <br /> r. US 7 ,4716 <br /> /1 <br /> /6 ) d- (06 l0 y• n S. <br /> EHD 48-06 8/04/ 8 PUBLIC RECORDS RELEASEAPP FORM <br /> 20/10'd 66T0 998 S76 T Cd1dHOdaODNI 030N3 ££:9T 6002-T2-ddb' <br />