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EHD LOG NUMBER <br /> #' 1T DD SAN JOAQUIN COUNTr[77�'IM L��7, Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ���`• ' c0 600 East Main St. Stockton, CA 95202-3029 <br /> NV(I iJIVl4'I:tl�i HE R"one: (209)468-3420 Fax: (209)464-0138 Web: Www.sjgov.orgl <br /> 5�5 70 q <br /> PERVIITiSE�VICE;,S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 'P-�L��' 1 BUSINESS/AGI_NCY: tkowVim .] <br /> ADDRESS: fr. K C._. P" UO CITYISTATFJAP:_ 9"7-- <br /> PHONE(1): 0109-LI-LI-1-711D <br /> 109-LI- I -=I"IOD PHONE(2): FACSIMILE:abs <br /> TENTATIVE*APPOINTMENT DATE: Time; /0., o D q , m , <br /> (Please allow 1U buainees days from data of application submittal-'Tentevve only-must be confirmed) <br /> i ❑CHECK sox t4 EXPEDITF REQUEST- 1 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 313USINESS DAYS <br /> SIGNATURE OF APPLICANT DATE X11-7 I I O _ <br /> Electronic Information: ❑LISt[I Map--Description: <br /> I) <br /> FILE ADDRESS EHD USE ONLY <br /> 8tnaat Street Name City Ii El unit 1 <br /> 1. r14 W -L-fl$. 11 <br /> 2. (2-o c,,-6A- �� � [j Unit 2 <br /> ZI <br /> s. 3 5 ' <br /> 4. ❑Unit <br /> 6. i( <br /> 6. nit4 <br /> 7. a <br /> S. i;� ❑Unit S <br /> 4 $. <br /> 10. i ❑Unit 5 <br /> Specific Date Flange of Information Requested: From 19 Wr to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE$ <br /> ❑UNDER13ROU140 TANK(UST)CLEANUP SITE(LOP) ❑HOuSING ABATEMENT p ❑SOLID WASTE FACILRYNEHiCLE <br /> ❑OTHER CLEANUP SRE(NOH-LOP) ❑FOOD FACILMY ❑WASTE TIRE 4 <br /> ❑UNDERGROUND TANK(MoNITORINGIREMOVAL) ❑DUG KENNEL ❑DA1RY <br /> I FDFEAZARUOUS WASTE GENERATOR ❑CHICKEN RANCH ° WA8TEWATERTREaTMENr PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEOHOTEL ❑Pt)MPER TRUCKUYARDICHEMICAL TOILETS <br /> ❑TATT001BODY PIERCING ❑POOLISPA j ❑LAND USE APPLICATION SIiEB <br /> ❑ MFOICAL WASTE FACILITY 'OTHER(PLEASE_SPECIFY) �lnira�rY S t?tilOi G�Y nq( �t_ <br /> WELL AND SEPTIC PERMIT RECORDS ARE,AYAILAvLF FOR REVIEW: MONDAY-FRIDAY$.00 A�M 06m(EXCLUDING IJOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(as). At least one file type MUST be selected. Fax to -0136 or mail addre$s indicated above. Address <br /> ranges will not be accepted-for additional aasl&tanCB With file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> �R <br /> 2. The£HD 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 /> I 3. A file that is actively being worked on by EHD staff may not be Immediately for review. A new application may be <br /> submitted when the file Is available. available!' <br /> 4. Any rile not returned In the same condition as released will be reorganized by EHD staff at the expense of the appllcant. <br /> �. Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> r EHo u6F ONLY <br /> r <br /> i <br /> u <br /> EM 4"S p712911 <br /> 1I <br />