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ver err �V V 9 1 V 1V: Ya rriA IQJ001/401 <br /> GATE RECEIVED EHD LpG NUMBER <br /> SAN .1OAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgoV.Org1 <br /> PUBLIC RECORDS RELEASE APPLICATION n <br /> APPLICANT: I C'.. L o c kk a r+— BUSINESSIAG(E�NCY: & S r <br /> ADDRESS: c�I L' 601d CQfn'1 r/ V 'L # I 0I�LLt/� (i t: �?Q/llii LM�L. SC[� �C: <br /> PHONE(11):_% ' -922 9 3 PHONE(2); FACSIMILE: <br /> Ir- OD TENTATIVE*APPOINTMENT DATE: (0 15/G -Time- 4 N <br /> (Please allow ten buslnass days from date of application submittal-'Tentatlye only-must ba con med) <br /> 0 CHECK 60X TO EXPEDITE REQUEST-$98. CASH OR C�HE Y)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ IC�� '�<` — DATE <br /> EleCtroniC information: KList❑Map-Description: C—D>2 TZ aGt i to s /tits(yo <br /> _ FILE ADDRESS EMD USE ONLY <br /> Street# Street Name _ City ❑Unit 1 <br /> w• Oraki- I fit. 40ad 1 rC( F <br /> 2. _ .- rrac q:5-3I /-J, ❑Unit 2 <br /> 3 3Ul Q .I Trac tit S <br /> 4 td SC) r0 s ��. C�• Tr ( 4 r nit3 <br /> 5 W GrastE -fn;- Road 7-1-4Z � \ <br /> Tra L A), nit4 <br /> 7 ?'C)o Rj ra vt f goarr( 7`rar gfS3 <br /> 8. 20 r._G.N.k 1las-, ifooLd TrCcf qs-,5� . �^ ,f- ❑Unit 5 <br /> 9. 13 '�f 8 U ;tee, 2O e& 7-r,,u <br /> 10. nit 6 <br /> I <br /> Specific Date Range of Information Requested:From to <br /> �,,( ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> y`+ <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT SOLID WASTE FACILITY/VEHICLE <br /> J�OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 9WASTE TIRE / <br /> UNDERGROUND TANK(MONITORING/REMOVAL) DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR d CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 171 TIERED PERMITTED FACILITY 171 MOTEL/HOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 171 TATTOOIgODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> 17 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW•MONDAY-FRIDAY 8:00 AM-S:OOPM- EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the We(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 above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 300 pm will <br /> 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 <br /> days after receipt Of application. The files will be held for a maximum of fivo business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by the EHD staff may not be immediately available for review. A new application <br /> may be 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$98.00 deposit prior to review. <br /> END USE ONLY <br /> EHD 48-06 10129/07 PUBLIC RECORDS RELEASE APP FORM <br /> I <br />