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DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOCA NUMBER <br /> ENVIRONMENTAL HEALTH D1=PARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjg 4140 <br /> �PUBLIC RECORDS RELEASE APPLICATION /� <br /> APPLICANT: �IG1 � (IdNDOL11=0 BUSINESSIAGENCY: eNj �]'t;U <br /> ADDRESS: _ S d W11IMw A n 0 <br /> _ CItylState/Zip K(✓k, l:0- 9Qrn <br /> PHONE(1): 2.G4-bk 68Y--4 6 04 PHONE(2): 7,04 2I .2 <br /> FACSIMILE: r d�q -a�9 <br /> TENTATIVE*APPOINTMENT DATE: (ZO"Q Time: R:50 <br /> (Please allow 10 business days from data a plication Submittal-"Tentative only-must be confirmed) <br /> 13 CHECK 13OX TO EXPEDITE REQUO4105 F C HO ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS GAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name <br /> City <br /> / f. [D Unit 1 <br /> r Y� • I D <br /> 2. 1 Q h S OC Sy.. '4ve? ❑ Unit 2 <br /> 1. <br /> F3. ' ✓ <br /> 4. 3 ,Z o S. s-focu+C) , Ave- sa£t <br /> Unit s <br /> 5. � S- a;� 3 v <br /> 6. _5 4 ag ?F�UnR4 <br /> 7. 3�( l � .0. Asa <br /> 8 133_13� L j, 14 � � ✓ ❑ Unit 5 <br /> g. L u.r <br /> 10. Z 3 ❑ Unit 6 <br /> Specific Date Range of Information Requested:From _ aAP 1;91} to 121-ci 2AA <br /> ,.// ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Jsl-UNDEROROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> VOTHER CLEANUP SITE(NON-LOP) t3 FOOD FACILITY D WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL d DAIRY <br /> ,0_HAZARDOU5 WASTE GENERATOR D CHICKEN RANCH D WASTEWATER TREATMENT PLANT <br /> D TIERED PERMITTED FACILITY ❑MOTEUHOYEL C3 PUMPER TRUCKIYARDICHEM TOILETS <br /> 11 TATTOO/BODY PIERCING D POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WAsYE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW -MONDAY-rRIDAY 8:00 AM-5:QOPM - 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 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 EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of applleiption. 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 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 43-08 8/04/00 PUBLIC RECORDS RELEASE APP FORM <br /> TO 39Vd N0dIH039N3 S62-166SGOZ Tb:TT 8002/LT/ZT <br />