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I <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUiN COUNTY <br /> a f}��t '�, `Eil) ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 l=ast Main Street, Stockton, CA 95202-3029 57 <br /> :v ; 2008�$ Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ d <br /> CidVi , 't 1 ,IT PUBLIC RECORDS RELEASE APPLICAT /�? <br /> IO <br /> ii L'�{AAIIG'Jt� A ,E D =L 1 BUSINESSIAGENCY: C AIL TR I Y S <br /> ADDRESS: 1176 jf, C/Ylq­rg�i_4X eAlq 7 :5-ree/�7-46f 0 S'• <br /> PHONE(1}: q y 6 r 7 Op -7-3 PHONE(2): Zo 45 / - /3 FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Aune_ 17 A04000 Time: !D B a Aly <br /> (Please allow ten business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-598.00 FEE&ASH OR CHFfCALY)-REgUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 5 Z 3—,09 <br /> Ir}ectroniC Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street street Name <br /> cies a <br /> Unit 1 <br /> F2. <br /> yC11AC%4k �� p� ❑Unit 2 <br /> 3. <br /> 4 <br /> ❑Unit 3 <br /> 6. <br /> 7 <br /> nit <br /> 8. 0 0 6 Ufil� , <br /> G 1 <br /> 9. Unit 5 <br /> 10. <br /> ❑Units <br /> Specific Date Range of Information Requested ' <br /> From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP$ITE(LOP} ❑HOUSING ABATEMENT <br /> OTHER CLEANUP SITE NON-LOP SOLID WASTE FACILITYNEHIGLE <br /> ❑UNDERGROUND TANK MONITO } ❑FOOD FACILRY _ ❑WASTE TIRE <br /> 0 H { RINGIREMOYAL} Q DOG KENNEL [� <br /> A2/1RDOUS WASTE GENERATOR DAIRY <br /> In TIERCD PERMITTED FACILITY ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TATTOO/BODY PIERCING ❑MOTELlHDTEL r-3 PUMPER TRUCKlYARDICHEM TOILETS <br /> MroICAL WASTE FACILITYPOOLISPA <br /> ❑OTHER(PLEASE SPECIFY) ❑LAND USE APPUDAT7pry$ITEg <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 checkingthe appropriate <br /> boz(es). At least one file type MUST be selected. Fax to 2fM 484-0438 or mall to a above ddress. Addrs raes will <br /> not be accepted-for additional assistance with file addresses,contact the EHD g <br /> be processed the next business day. • the <br /> received after 3:00 pm will <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten <br /> days after receipt of application. The files will he held fora maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by the EHD staff may not be Immediately available for review. A new application <br /> may be submitted when the file Is available. <br /> 4. Any We 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4&46 10129!07 <br /> PUBL1 RECORDS RELEASE APP FORM <br /> T •cl 2$LG6ir66OF, sue,A-4te0 d136 -20 80 E2. ReW <br />