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DATE RECEIVED SAN JOAQUIN COUNTY EMD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sJ9ov. d <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 'AA BUSINESSIAGENGY: N <br /> ADDRESS: SIT) N orA� w.t IW. Q , /� r'6 7 <br /> rr GitylStetel2ip !�I��ti^ � 9,? V,7� <br /> PHONE(1): 'Zo �� �Gool PHONE(Z): Z-4°i 3�L I Z6& FACSIMILE: Yp G <br /> TENTATIVE`APPOINTMENT DATE: i z:'Lo-0p Time: F 3° <br /> (Please allow 10 business days from date 01 applicailon submittal-"rentative only�must be confirmed) <br /> © CHECK BOX TO EXPEDITE REQUE - 05 F A R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTT DATE W- <br /> Electronic information: © List 0 Map-ascription: <br /> FILE ADDRESS EHO USE ONLY <br /> Str"tt 0 /1 Stroat Name S(I- <br /> I <br /> 7. 3 <br /> 014 1.��' �b+ � ❑ Unit <br /> 2. a tart Tin Jra �' ❑ Unit 2 <br /> 3. I b IN 55 <br /> 4' adv; •�. S r4 .35 Unita <br /> 5. <br /> 6. --— Unit 4 <br /> 7. <br /> S A0 Unit51 1` <br /> 70. <br /> (3 Unit 6 <br /> Specific Date Range of Information Requested;From.� to "f <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ;3-,UNDrRGROUNO TANK(UST)CLEANUP SITE(LOP) CI flousiW A5ATEMENT I7 SOLID WASTE FACKITYIVE141CLE <br /> WOTHER CL12ANUP SITE(NON-LOP) CI FOOD FAoLnY <br /> 0 WASTE TIRE <br /> P(UNDERGROUNOTANK(MOMTORING/REMOVAL) 0 DOa KENNEL 0 DAIRY. <br /> GirHAZARDOU6 WASTE GENERATOR 0 CHICKEN RANCH C1 WASTEWATER TREATMENT PLANT <br /> C7 TIERED PERMITTED FACILITY C1 MOTELlHoTEL I7 PUMPER 7RUCKJYARDICHEM TOILETS <br /> M TATTOOIBDoY PIERCING 13 POOL/SPA • C3 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASYE FACILnY Q OTHER(PLI=ASE SPEciFY)___ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MaNDAY-FRIDAY 8:00 Aga-5:00PM • EXCLOWNG HOLIDAYS <br /> 1. List up to ten addresses in the space above, Select the types)of files from the list above by checking the appropriate <br /> boX(es). At least one file type MUST be selected. Fax to(2091464-0138 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 END files exist An appointment for review will be confirmed approximately tan(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$10S deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48.06 BM4105 PUBLIC RECORDS PELEASE APP FORM <br /> 7,0 39dd N06IN03ON3 5SZT88580Z Ib:tt 8002/LZ/Zti <br />