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EHD LOG NUMBER <br /> �nS SAN JOAQUIN COUNTY <br /> �:►'i� 1 ?��� ENVIRONMENTAL. HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIRMMENT HEALTR1ephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.oqZ95% <br /> PE�MITI�ERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: / N 01 BUSINESSIAGENCY: F-GCSE O ,` <br /> ADDRESS: too N. -W� ,1�/l�ima, 8ye- Jfe A City/State/zip R1� Ca,-- -1.5-3610 <br /> PHONE(1): �/`�"l -l1Otl7 PHONE(2): VA_.Z'Zi_- 2Ca�_OF_ —FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE. MD-re+. !�i 7-0041 Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE RE T- 0 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> u <br /> Electronic Information: ❑ List❑Map-Description: <br /> _ FILE ADDRESS _EHD USE ONLY <br /> _ Street# Street Name City <br /> - E] Unit 1 <br /> J 1. — b� C S7. a'-- aJ F, F <br /> 2. �Jl�. ��SL AA* _do� . ..... �� 6 'UIc� ❑ Unite <br /> 11011 <br /> Unit 3 Lr� <br /> 4.Na ao a� ,J �, -- (U <br /> nit <br /> • .2 1 n M 1" <br /> 7. <br /> -- - Units <br /> a 019 o Vj. <br /> fi. .---._../ .[�__D_.. :S - ❑ Unit6 <br /> lo- <br /> Specific Date Range of Information Requested:From Cel heli- to W04 lleC,^+ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> "Q UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> rIOTHER CLEANUP SITE(NON-LOP) C1 FOOD FACILITY ❑WASTE TIRE <br /> . .UNDERGROUND TANK(MONITORING/REMOVAL) ❑Don KENNEL 0 DAIRY <br /> ZMAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY O MOTEUHOTEL ❑PUMPER TRUCK/YAROICHEM TOILETS <br /> ❑TATTQoffiom PIERCING ❑POOL/SPA O LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 5:00 AM-5:00pM - 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)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. 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 application. 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 48-06 8104/08 PUBLIC RECORDS RELEASE APP FORM <br /> EO/TO'd 6620 998 SZ6 Z C311Ji0&J0DNI 030N9 22:9T 600Z-TF-Jdd <br />