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� EHD LOG NUMBER SAN JaAc�UIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ��P 0 3 Z�pg 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone; (209)468-3420 Fax: (209)464-0138 Web:wvM.sjgov.ar le <br /> ENVfRoNMENT HE T9 <br /> pffiCE5 PUBLIC RECORDS RELEASE APPLICA N <br /> APPLICANT: jjUa1A!481.13I VESSIAGENCY: <br /> ADDRESS: 902 Industrial _ - city/statarzlp -Lod4 _ 95240 <br /> PHONE(4): 209, 7-.3701- PHONE(2): FACSimiLE: 209-369-4228L.— <br /> TENTATIVE"APPOINTMENT DATE: Time,,_...—. <br /> (Plaaso allow 10 business days front date of application submittal-"Tentative only-must be confirmed) <br /> CHECK BOX TO ExPEOITE REQUEST $106 FE ASH Oft CHP-OK ONLY)-RitQUEST PROCESSED IN$BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 141 <br /> Electronla information: List[]Map-Descriptio . <br /> nLE ADDRESS EH13 USE ONLY <br /> Street# Street Name City unit 1 <br /> x- c %mm— <br /> L <br /> El <br /> 4. Lj Z 1q � �n� c���._G VC. � K- ,t1, U nit a <br /> 5. <br /> - - Unit 4 <br /> 7, T ❑ "units <br /> 8, <br /> 9. <br /> ❑ Unit e <br /> Specific Date Range of information Requested:From to <br /> ENVIRON MENTAL.HEALTH DEPARTMENT FILES <br /> t <br /> NDERGROUND TANK(UST)C""ANUP SITE(LOP) E1 HOUSING AeAItMENT Ea SOLID WASTE FACturYNExIcLE <br /> THER CLEANUI'SITE(N.. <br /> -LOP) A FOOL FACILITY d WASTE TIRE <br /> NDERGRCUNA TAN%(M. tTORINo1REM0VAL) d DOG KENNEL C7 DAIRY <br /> A7RDOUs1NASTEGENERATOR Gi CHICKEN RANCH Cl WASTEWATER TREATMENT PLANT <br /> re,R D PERMITTED FnCI W A MOTEL/HOTEL ❑PUMPER TRUCWYARDICKFm Tau�Ts <br /> TATTooraoDY PIERCING ©POOLlSPA 0 LANo use APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ETHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECbhbs ARt AVAILAaLy Fon f2EvIEW- MONDAY-FRIDAY 8:00 AM-6:00PM -EXCLUDING HOLIDAYS. <br /> 1. hist up to ten addresses In the space above. Select the type(s)of files frons the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464DAAe oar mala to the.addreas Indicated above._ Address <br /> ranges will not be accepted--for additional assistance with file addresses,contact the END, Applications received after <br /> 3:00 pm will be processed the next buslness day, <br /> 2. The EHD will notify the appilcant if any EblD.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 RHD 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 staffat the expense of the applicant. <br /> Future file reviews by the same appilcant may require a$106 deposit prior to review, <br /> END USE ONLY <br /> EHD 48.06 8104108 PUBLIC RECORDS RELEASE APP FORM <br />