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DATE RECEIVED ,SAN ,JOAQUIN COUNTY EMD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> 1��Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> nJ 4i( R�IVA <br /> �FONt`AEN- v1GES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: _S e�vet�l BUSINESS/AGENCY: ff�lob, a�eo <br /> ADDRESS: Od cJ,��/�/1 e kl P. 02. CITY/STATE/ZIP: , 7a C f-Lm,P ILA 191 y 1// <br /> PHONE(1): PHONE(2): /67 9-7762- FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: l a/I X02 _ Time: g cj M <br /> (Please allow 10 business days from dato of ap Ilcation submittal-`Tontadve only-must be conflrnle ) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(C R C CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ,,o_ -���_ _ DATE ��� <br /> Electronic information: 71 List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Vi Street Name City Unit 1 <br /> 1. 2.3�I 5 ✓� tee_ -% i ,, - <br /> Z. —4 4.1 D?f,t vc GF_.i Un Q Unit 2 <br /> 3- <br /> 4. UnIt 3 <br /> 5. Pz A-o,C11 e tri`tQ3 -.0, <br /> / I <br /> s. U� an res 0 F'�eS 1 2 tl ctJfJ <br /> U <br /> 7. <br /> +,S�l>A ��lp:S o �° auk S Ali !rl <br /> 8. <br /> 9. <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT JtSOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY JMVASTE TIRE <br /> ,UNDERGROUND TANK(MONITORING/REMOVAL) DOG KENNEL rrDAIRY <br /> HAZARoouS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ,TIERED PERMITTEE]FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TATTOUIHODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> © MEDICAL WASTE FACILITY XCOMPLAINTRECORDS ❑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 un 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 now 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$125 deposit prior to review. <br /> r lgrj Usk ONLY <br /> EHD 4M6 <br /> tl11111 <br /> ZB/Z© 39dd ONI -1VHIN3S0�J a3GNIS b06b8L69TG 59:ET TTBZ/Ta/ZT <br />