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DATE RECEIVED ��' EHD LOG NUMBER <br /> SAN JOAGIUIN COUNTY <br /> vE® ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> O`� 0 1��Telephone: (209)468-3420 Fax: (209)464-0138 Web:www,sjgov.org/ehd �,/ <br /> 145 <br /> ctakXto �v IceS�HPURLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 'Ve a rt?In BUSINESS/AGENCY: &4106, QD Tp,C. <br /> ADDRESS: O 1 ern 091✓r. P. OZran rLf9y. qCITY/STATE/ZIP: , SacP. <br /> _ I6 <br /> PHONE (1): T(P—q?x'4100 PHONE(2): /6�// /�7Z(oZ FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: la//i // Time: BgYVI <br /> (Please allow 10 business days from date of apVlcadan submittal-"Tentative only.must be comirime ) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$11225 FEE(C RC CK ONLY)-REQUEST PROCESSED INS BUSINESS DAYS <br /> SIGNATURE OF APPLICANT p. o _ DATE / <br /> Electronic Information; ❑List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 5ereat Y/ Street Name Clry Unit 1 <br /> 1. 23115000 �wp_ <br /> 2. -Z9 03(I v r on O unit 2 <br /> 3. `L,4) (y7 a r✓P I a2�� ck w V <br /> 4. ( N C -"f Dil Unit 3 t� <br /> 5. CD Pak}oCl1e �1�iQL <br /> 8. UP_ qn y c�.S O ! f'�es 12/011 Ct/eJ unHa <br /> 7. 5tJ T `I6-:,C Q rooed-Aiaul S 9r /� <br /> 6• �- ..-'� ovc'_. 4' ..P _S unit <br /> 9. <br /> Unit s <br /> Specific Date Range of Information Requested: From to <br /> }�'' ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> y-UNDERGROUND TANK(UST)CLEANUP SITE(LOP) *,DOG <br /> HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NOWLOP) FOOD FACILITY ASTE TIRE <br /> 9,Xy UNDERGROUND TANK(MONITORING/REMOVAL) KENNEL DAIRY <br /> 11AZAROOV5 WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ,TIERED PERMITTED FACILITY D MOTEUHOTLL <br /> ❑TATTOO(BODY PIERCING ❑PUMPER TRUCKICATION SITES TOILETS <br /> ❑PODUSPA ❑LAND USE APPLICATION SITES <br /> © MEDICAL WASTE FACILITY XCOMPLAINTRECOROs ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW; MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING 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 mall 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 hold 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 EMD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> PHO Uae ONLY <br /> EHO 41"S <br /> a11N1 <br /> ZO/Z0 39Vd DNI -1VH.LN3S0b N30N3E 00668L69T6 SO:£T LIOZ/10/ZT <br />