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Apr 11 013 11 : 55a P- 1 <br /> UAIt KLUtivtu EHD LOG NUMBER <br /> G°) I GL' ��\�� SAN JOAQunv COUNTY <br /> �1 L� J I�� ENVIRONMENTAL HEALTIi DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> ��j; 3 1 LOIJb Telephone:(209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd 30q4 <br /> ENVIR0.11Vit Jl- I1c,a,LTH <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: THE C H Chill) (-Q,it _ BUS INES SIAG ENCY: <br /> ADDRESS: 42-03 �UVL.LZW ST, CITY 5ToC V STATE <br /> PHONE(1): 9 rl -S9 Ir"I PHONE(2): ucj_�- (GC�5 FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confimed) <br /> Q CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT . "i-'kif6l, DATE <br /> Eformatilc 13 List ❑ Map-Description !� <br /> Information <br /> FILE ADDRESS END USE ONLY <br /> Street# Street Name City <br /> 1. qJC) ) E. MAIN <br /> 2. ST N 11 Unit 1 <br /> 3. 41 ❑ Unit 2 <br /> 4. i� <br /> 5. Unit 3 <br /> 6. <br /> 7. Unit 4 <br /> s. <br /> 9 ❑ Unit 5 <br /> _'' ❑ Unit 6 <br /> Specific Date Range of information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑$OLID WASTE FACILITYNEHICLE <br /> JR OTHER CLEANUP SITE(NON-LOP) ❑FOOD FAc&m 0 WASTE TIRE <br /> Q UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL 0 DAIRY <br /> 9 HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERmtTrw FACILITY M MOTELIHOTEL C3 PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING D POOLISPA LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REyIEw-MONDAY-FRIDAY 8:00 AMS:OOPM - EXCLUDtNG HOLIDAYS. <br /> t. List up to ten addresses In.the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address <br /> Indicated above. Address ranges will not be accepted—for'additional assistance with Fle addresses,contact <br /> the END.Applications received after 3:00 pm will be processed the next business stay. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> ion 120o6 <br />