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Igo <br />DATE RECEIVED SAN JOAQUIN COf;&TEME90 <br />EHD LOC, NUMBER <br />-.. 9-"- -"" V fo ENVIRONMENTAL HEALTH <br />600 East Main St, Stockton, CA 95202-3029 <br />1�1Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT:---�r+e-y2 I o re Vt -T BUSINESS/AGENCY: Teiiob.r F-esLi&j 1,C�j <br />ADDRESS: v, d0 61rll 191LI P. CMZ, CITY/STATE/ZIP; , 7a rnnn(, 6 IK �5�1.. `ll <br />PHONE (1): PHONE (2): !N—%/ 9-7Z (07— FACSIMILE: <br />TENTATIVE APPOINTMENT DATE: 1 a -2-L// Time: 8 q !2a <br />(Pleaso allow 10 business days from dato of applicationtal "Tentadvo only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CR C CK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE /��Lllr <br />Electronic information: T] List ❑ Map -- Description: <br />FILE ADDRESS <br />END USE ONLY <br />Unit 1 <br />Street 0 <br />Street Name_ <br />_ <br />City <br />✓ it_ <br />W 7" � 460 03i&j <br />°Vr <br />T �-;unit <br />2. <br />�� I a? <br />c _ v� <br />a ,r✓P- <br />WtD AJ m4f, � <br />31126 -'eun It 3 <br />s. <br />� <br />Unit 4 <br />6. <br />LSP <br />n c..S O <br />7. <br />,,SCJ <br />+ f`tp_:SC? 42 rozv,- au) <br />S Ali Id <br />� Unit 5 <br />e.-O <br />t/c� � -� S'� - T <br />Unit 6 <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) HOUSING ABATEMENT SOLID WASTE FACILITYNEHIGLE -� <br />OTHER CLEANUP SITE (NON�LOP) FOOD FACILITY ASTE TIRE <br />AUNDERGROUND TANK (MONITORINGIREMOVAL) DOG KENNEL LjDAIRY <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />,TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKIYARU/CHEMICAL TOILETS <br />❑ TATTOO/EoDY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ACOMPLAINTA15CORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 5:00 AM-S: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 address Indicated above. Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the END. Applications received after <br />3:00 pm will be processed the next business day. <br />2. The END will notify the applicant if any END 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 END 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 END staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $125 deposit prior to review. <br />1"I'M UU. ONLY <br />END 48.08 . <br />811111 <br />Z0/Z3 39dd ONI -1VH1N3S0i0 N1IGN3E V06VBL69T6 59:ET TTOZ/Ta/ZT <br />7� <br />