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{ ?^'��;� ` SAN JOAQUIN L:OUNIY � 4rt <br /> ,rLk'`_ t <br /> NS yONMENTAL HEALTH DEPART N <br /> E <br /> �b1d fitx East Main St, Stockton, CA 9 =_ }' <br /> 520 y <br /> e�hone: (209) 468-3420 Fax: (209) 464-0138 We sigov.orglehd <br /> P-LRl,;11 1 P,';II LS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: tr1 Sic ZW CITYISTATERIP: C CSS qU pt�Z-�r� <br /> PHONE(1}: 0 tP PHONE(2):SI�`69g5`(2-� FACSIMILE: 1510 2- t5- 2�'�J�F <br /> TENTATIVE`APPOINTMENT DATE: f-_Y- 0. � 2() (] Time: AYn <br /> (Please allow 10 business days from date of application sub I- Tentadve only-must be confirmed) <br /> AHECK BOX TO EXPEDITE REQ T-$115 SH OR CHECK ONLY)-REQUEST PROCESSED 1N 3 BUST ESS DAYS <br /> SIGNATURE OF APPLlCA DATE <br /> GN �Q ZS I <br /> Electronic Information: ListDK Map— scription: t t0 ''Y`u'��' `r +� wc <br /> FILE ADDRESS e�. EHD USE ONL <br /> Street# Street Name City ©Unit 1 <br /> 2. L o u5TUnit 2 <br /> 3. iso e o :pro_ <br /> x y 1 <br /> QQ <br /> 4. CA,t .�.3�,�� °�� Unit 3 <br /> 5. <br /> 6. 2-23 GL ��fl }s_) Unit 4 <br /> 8. 1._ , Pro r\+C,- d ��� � r'' ❑Unit 5 <br /> IV <br /> 110. <br /> Unit 6 <br /> Speck Date Range of Information Requested: From u i C'• to _ y"p• t jc�j <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ��— <br /> $60NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT (SOLID WASTE FACIuTYNEHiCLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> 'ERUNDERGROuNi)TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> A7ARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> 19�IERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATToOIBODY 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-5:00PM(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:DO 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 bescheduled accordingly. <br /> 3. A file that is actively being worked on by EHID 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$115 deposit prior to review. <br /> 5. If you need further assistance, please contact Diane Martinez,at(209)488-3425. <br /> i EHD USE ONLY <br /> EHD 48.06 <br /> 8127!09 <br />