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oa„ Joaquin county —} 4640138 2 <br /> SAN JOAt�LIIy COUNTY EHD LOG NUMBER <br /> l�UV ` ENVIRONMENTAL HEALTH DEPARTMENT +0�1 <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Ef`!':`;(iL!v;',.:;-rFi T ! le hone: 209 468-3420 Fax: 209)464-0138 Web: www,sigov.org/e <br /> PER "'/SER'VICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT,_Dt�AR17- Rn,,�.2�f BUSINESSIAGENCY: <br /> ADDRESS: 4j• 0950 CITY/STATE/ZIP: 01 y S o a <br /> PHONE(1): (2oq t(- �,.. I0 R PHONE(2): FACSIMILE: ( q44-851-5 <br /> TENTATIVE'APPOINTMENT DATE: 1)rc 4 ���,� Time: IU;«; <br /> (Pfease allow 10 business days from date of appAcation submittal-'TonfeUve only-must he confirmed) <br /> CHECK BOX TO EXPEDITE REQ STT-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE_tJoV IBJ, ion y <br /> Efectronfc Informatlon: 0 List(]Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name A P N city ❑Unit 1 <br /> 1. )70� COIIrJrl2� ALLW &L d -.t Ju•D $ru(:KFUhI �c�� <br /> 2. � 13A r A4i 95A AD• 173.0&o•-3� u e p Unit <br /> 3' a�� 8rrt :J»tiJ 4N 015 190-1 L<�UJ <br /> 4. 13275 C' Hw 01'7•.0 t• Ln(:1<rl or J� <br /> 6- 35 N.6HC..ax,5C LM .. e:oft Lo01 <br /> 6. OJ K1 7'1114nl 0 5 -1 o-lq Lo 1tt4 <br /> 7. <br /> ❑Units <br /> 9. <br /> ❑Unit 6 <br /> Specific Dato Rango of Information Requested: From ;gyp n to /J <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORiN01REMDVAL) ❑DOG KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH (]WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKJ'YARDIC HEMICAL 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-6:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es), At least one file typo MUST be selected. Fax to(209)464.0138 or mall tq the address Indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EMD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The END 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 behold for a maximum of ffve 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 revlow. 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 raorganized 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 /> 6. If you need further assistance,please contact Diane Martinez,at(208)468.3426. <br /> EHe USE ONLY <br /> EHD 48-08 8117109 <br />