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DAME RECEIVED EHD LOG NUMBER <br /> SANJOAQUIN COUNTY <br /> +_ 1. ENVlRONMrzN-rAL-HEALTH DEPARTMENT <br /> F 660 East Main Street, Stockton, CA 952423029 0 <br /> f Telephone: (209)468-3420 Fak, (209)464-0138 Web. WWW.Sjg h <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> Cry v <br /> ' APPLICANT: 1?*mrQo (�ZN L..h"O BUSINESSIAGENCY: G- J <br /> ADDRESS: S�d Wll`nfw C1tyl$tatelZip el1�*14 <br /> h PHONE(1): U4-I G --16 O A PHQNIE(2): 264 2l 6 b S FACSIMILE: <br /> TENTATIVE*APPOWTMENT DATE: (Z-, c�-O Time: S_�D <br /> .(Please allow 10 buslno*S days from data a plication Submittal-'Tarr#arlve only-must be confirmed) <br /> Q CHECK 13OX TO EXPEDITE REpU $105 F C HO ECK ONLY)-REpUEST PROCESSED IN 3 BUSINESS bAY9 <br /> SIGNATURE OF APPLICANT DATE . '>rZ- <br /> Electronic Information, ❑ List[]Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑ Unit 1 <br /> 2' 1 hoc :5' ? © Unit <br /> 3. o ✓ Ap <br /> 4- Unit 3 <br /> r7. <br /> Uriit4 <br /> S • oZ ❑ Unit S <br /> 33 f� <br /> 9. —3aa— p e_vsj <br /> /cs' , a�` Unit 6 <br /> 10. Z 3 _t; C�Zl.4T�i'a A1rG <br /> l] <br /> Specific Date Range of Information Kequested:Prom a. r bE d j} to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 4NDEROROUND TANK(UST)CLEANUP$ITE(LOP) O H6u5lNG AGATEM.ENY SOLID WASTE FACII-ITYNE ECU <br /> 1 OTHER CLEANUP SIT$(NON•LOP) t3 FOGA FACIIm C]WASTE TIRE <br /> 7u UNr r.GROUND TANK(MONITOMNGIREMOVAL) Cl DOa KENNEL DAIRY <br /> iiA%ARDOUfi WASTE GHNERA1roR M CHICKEN RANG" l7 WASTEWATER TREATMENT PLANT <br /> TIEAEo PERAdl7=FACILITY - ❑'MOTEL1Ho7EL - CE PUMPER TRUCIc1YARDIC"EM TOILETS <br /> i` M TAT70O1BODY PIERCING O POOLISPA D LANo USE APPLICAYION SITES <br /> •13 MEDICAL WASTE FActLrry C7 OTHER(PLEASE SPE CIPY)_ <br /> WELL AND SEPTJC PERMIT RECORDS ARE AVAILA)3LE FOR REVIFW- MONOAY-rRIDAY 8:00 AmS;00PM - EkaLUnimc;HOLtpAYa. <br /> 1. Ltat up to tan addresses In the space above. Select the type(s)of fifes from the list above by checking the appropriate <br /> box(es ). At least one file type MUST be selected. Fax to WEI)4_64-0138 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 /> 3:00 pm will be processed the next business day, <br /> 2. The EHD wilt notify the applicant if any F_HD files exlst..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 schoduled accordingly. <br /> j 3. A file that is actively being worked on by-EHD staff may not be Immediately available for review. A now applicatl(3n 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 EHO staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHt)USE ONLY <br /> k <br /> EHD 48-ae slaarpB PUBLIC RECORDS RELEASE:APP FORM <br /> Z0 39bd ,. N0dId039N3 96LT665697, Tt, :TT 800Z/LZ/ZL <br /> i <br />