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UL/ 1 J/ LUU7 11.JO 1 DIUO e Do(U7 bILP ;K13UNN UUNSUL 1 1NU 1-'AUL bl <br /> V <br /> E <br /> EHI)LOG NUMBER <br /> D FI � DD SAN JOAQUIN COUNTY <br /> `'M � ENVIRO ENVIRONMENTAL L HEALTH DEPARTMENT <br /> 4-3 13 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sigov.org/eh <br /> ENVII�ONMEN T 11EALTH <br /> PEBPilTjSR`/ICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: � rQu�'� 1 BUSINESSIAGENCY: LA r4(te-Al��N6, <br /> ADDRESS: ZV 3_2 Fg V r- 7-,RE Z- City/State/Zlp I AleS-r S/`�LA-4Jl7Ert/TL) Cf� 9�j5691 <br /> PHONE(1): C116 . ­3_.7�.7V J(�, _ PHONE(2): 9/to- 7 9 - 2i/U7 FACSIMILE: �s•�" _ZS- 7�7 <br /> TENTATIVE"APPOINTMENT DAT S 'I77 [� 3J2 Time: /D <br /> (Please allow 10 business days�,Z.e&tlf app Icatlon submittal--Tentat/ve only-must be confirmed) <br /> 173 CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �aamg4 as DATE aa"1-1-14Z T9 <br /> Electronic Information: ❑ List❑ Map-Description:___ <br /> FILE ADDRESS EHD USE ONLY <br /> Street IF street Name City ❑ Unit 1 <br /> 1. zoos N /11Air✓_ 7/ 3� �Ak7 �A <br /> _ Unit 2 <br /> i. y8 o c) ��eo yr R d _ � 3�a �3 oa r <br /> 3. AS t ss l <br /> 4 _ nit 3 <br /> _. <br /> nft <br /> 4 <br /> 7. ❑ Unit 6 <br /> 6. <br /> 9. <br /> ❑ Unit a <br /> 10- <br /> Specific Date Range of Information Requested: From to Eg ESL-,AIT _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IIIII UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C7 HOUSING ABATEMENT d SOLID WASTE FACILITY/VEHICLE <br /> W OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY C3 WASTE TIRE <br /> 0 UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL DAIRY <br /> 2 HAZARDOUS WASTE OFNERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMIT-mt)FACILITY M MOTEUHOTEL PUMPER TRUCKIYARDICHEM TOILETS <br /> 171 TATTOOMODY PIERCING ❑POOL/SPA LAND USE APPLICATION SITES <br /> 17:1 MEI)ICAL WASTE FACILITY E3 OTHER(PLEASE SPECIFY) <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 types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209),464-0138 or mail to the address;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 business day. <br /> 2. The CHI]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 /> 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHq a8-o6 BIO'�oa�' PUBLIC RECORDS RELEASE APP FORM <br />