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I <br /> S® EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 5NVIRONMENTAL HEALTH DEPARTMENT / �� � <br /> SUN 600 Fast Main St, Stockton, CA 95202-3029 �y <br /> NTO�ITone : (209) 468-3420 Fax: (209) 464-0138 Web : www . sjgov .org/ehd `� <br /> RaNM11sERvtc�s PUBLIC RECORDS RELEASE APPLICATIpN <br /> APPLICANT: cleH 1 tA . BUSINESS/AGENCY: <br /> ADDRESS : -31JEjoi l &re4.:% A SLt . L' CITY/STATEIZIP : Sw2va .lwevt�at cA �=7tt <br /> PHONE (1 ): tj (, - 0M),$6 PHONE (2) : FACSIMILE: (qtq&O - 060-5 <br /> TENTA IVE' APPOINTMENT DATE: Time: <br /> (Pl#ase allow 10 bdsinan days from date of application Submittal , 'Tentative only • must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST - 122 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT A ,e _ I^ DATE Icta ( 70 <br /> Electronic Information: ❑ List ❑ Map - Description : <br /> FILE ADDRESS END USE ONLY <br /> Stmat # Street Name City ynitt <br /> 2 — S . trr< r} ._ c ✓ nh 2 <br /> 3 . 53 5 . 11tCr / <br /> 4• <br /> 5. <br /> e • b3�1 S 9 [ unit + <br /> 8. <br /> _ O Und S <br /> 9, <br /> 111. <br /> nit 6 <br /> Specific Date Ranaa of Information Requested: From 11100 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES —/ <br /> . I�-✓-jl,l1�NDERGROUND TANK (OST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT 15 ID WASTE FACILITWWRICLE <br /> t,tx HER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY STE TIRE <br /> [�DERGROUND TANK (MONRORINGMEMOVAL) ❑ DOG KENNEL RRY <br /> ARWUS WASTE GENERATOR ❑ CHICKEN RANCH STEWATER TREATMENT PLANT <br /> Y--I TIERED PERMOTEO FACILITY ❑ TELIHOTEL UMPER TRUCKNARDICHEMICAL TOILETS <br /> LI—J.T(A� TTOOIBODy PIERCING �OLISPA �ND USE APPLICATION SITES <br /> 2 MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILASLE FOR REVIEW: MONDAY-FRIDAY 8 :00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br /> 1 . List un to tan 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) 4640138 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 EH13 files exist. An appointment for review will W confirmed approximately tan (10) <br /> days after receipt of appllcatlon. The flies 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 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 $122 deposit prior to review, <br /> END USE ONLY <br /> ENO de-06 <br /> a>Ralta <br /> 100 / 100 [1 XvT BE04 ILOE / bL / 90 <br />