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.Jul uu u I t 1:1 ba Apex 209 667-9668 p.1 <br /> L�P.T12-F2ECEIVED EHD LOG NUMBER SANJoAqurN COUNTY -- <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-27 <br /> Telepbone: (209) 468-3420 Fax: (209)464-0138 Web: w-ww.sjgov.org/ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ Dream 4n A�kk-n RUSINESSIAGENCY: riu2X <br /> ADDRESS: 34U N- Cf�It�Q� S1a T31�. t <br /> PHONE(1): ZA`� ��o� �gi'}�'} <br /> PHONE(2)' FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time' <br /> (Please allow 10 business days from date of application submittal-'Tentative only-m �9d <br /> y must be confirmed} <br /> CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name -- <br /> City <br /> 1. S l l S S. Et D�rano g ►.1- ✓ El Unit 1 <br /> 2. f�. l�.g�. nab—401-- L,_ <br /> odi jot 1 t El Unit 2 <br /> 3. SSSS_ CrJ. k4 Vann Nn t r La oki- S 4.�C k-}�,� <br /> ❑ unit <br /> _ G a�c r l�A KAc}cl Sf�c k�� <br /> Unit 4 <br /> 7. -- - ✓ . <br /> ❑ Unit 5 <br /> 9. - --- <br /> • --— - - -- ❑ Unit 6 <br /> 10. - <br /> Specific Date Range of information Requested:From <br /> to <br /> 1 / ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> lhl UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING A$ATEMENT <br /> Q OTHER CLEANUP SITE(NON-LOP) 0 SOLID WASTE FACILITYNEHICLE <br /> ) <br /> ❑UNDERGROUND TANK(MONITORINWREMOVAL 11 FOOD FACILITY 1:1 WASTE TIRE <br /> ❑HAZARDOUS WASTE GENERATOR DOG KENNEL ❑DAIRY <br /> D TIERED PERMITTED FACILITY C3 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> G TATTOOIBODY PIERCING 0 MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> 173 MEDICAL WASTE FACILITY 17 POOLISPA Cl LAND USE APPLICATION SITES <br /> Cl OTHER(PLEASE.SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select thee s of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax t t(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 EHD.Application <br /> 3:00 pm will be processed the next business day. s received after <br /> 2. The EHD will notify the applicant if any END files exist. An appointment for review will be confirmed a <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointmat ten(10) <br /> should be scheduled accordingly. ppoinnts <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A raw 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 ex <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review. pense of the applicant <br /> EHD USE ONLY <br /> EHD 4E-06 9/13400E - <br />