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.1',�Jy�, L Szeia <br /> elf:i'R��:L'n�.�l .�� t..<,•.•r:'Z�.�+�Yr iMs� - .. .. .r• .,.r �x], V".�iM. 'Y 7.. , r k^�,�1�f <br /> RE Y <br /> IAV' I li <br /> J l�� SAN JOAQti IN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTINIENT <br /> AU' 2005 344 East Weber Avenue, 31'd Floor, Stockton, CA 95202-2708 jq313 <br /> Telephone: (209)468-3420 tax: (209)464-0138 Web: www.sigov.org/elid <br /> ENVIRON'14ENT HEA'JH <br /> PERMT/SEPNICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Q i�,r�' 1� "� BUSINESSIAGENCY: N:SLC <br /> ADDRESS:—Z-� �w�-a Tyr\��1� <br /> PHONE(f): Z�7 ��� y PHONE(2): 'ta FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: B Time: Oq <br /> (Please allow 10 business days from date of application submittal•*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-5`9{3.000 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 USINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNrr DISTRIBUTION ❑ Unit 1 ❑ Unit 2 0 Unit I.Runit ❑ Unit 5 ❑ Unit 6 0 Other(electronicllistslmaps) <br /> FILE ADDRESS I EHD USE ONLY <br /> Street A Streat Namo ; city <br /> 1• l� I b-a� 5 i S C.1� � <br /> 2. y d S Mv"' t\_ LK a L <br /> 3. -53oZ "�.4- Lo -_ I t <br /> 4. 2285 E, �r-e_...o a* S�_ S <br /> 5. 153 S. 1 usc-Ich- <br /> 6. <br /> 7. Co`B l S vac <br /> 8. ('S 10 o ro lit �K y>7 <br /> 9. J V�\_ <br /> 10. -Zj-yL- e• Mart g L` <br /> Specific Date Range of Information Requested:From Z.y`�3 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )SZ1U.14DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SCLID WASTE FACILITYWEHICLE <br /> ❑OTHER CLEANUP SITE(Nowt-OP) ❑FOOD FACILITY ❑WASTE TIRE Q <br /> ❑ UNDN <br /> £RGROUNDTAK(MONITORINGIREM13d OVAL) DOG KENNEL DAIRY <br /> =44ADW O(SMh►ST£GeNOW'tOR CNalb1'iiIVJOM Z7ivaSTEWAYMi�L'Y11T11QIrf�llM <br /> ❑TIERED PERMITTED FACILITY ❑MOTELMOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOO(BODY PIERCING ❑POOL/SPA Q LANo USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑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 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)4640138 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with file addresses, contact <br /> the EHD.Applications received after 3:00 pm will b'e 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 <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 /> 1 <br /> 3. A file that is actively being worked on by EHD stafll 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 /> EHD 48-02-DIK <br /> v�aros <br /> i <br />