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FE <br /> ^� SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> LE D <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> U' ! Z 7 200° 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464 0138 Web. www.sjgov.ogd <br /> ENV1Rur4mtw i I-JEALTH <br /> R Rf n,ITizs v rm 'PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTL,Z�i r Ct BUSINESS/AGENCY: fir1 �rJ.cr.s <br /> ADDRESS: 3LI3LI (!aftOn' Ave. CITYISTATEIZIP: Slcfa.� 1n <br /> PHONE(1): qa ` f�O 0;,�`3 PHONE(2): FACSIMILE: `(t6 451?r)40 L <br /> TENTATIVE'APPOINTMENT DATE: ASAP Tlme: <br /> (Please allow 10 business days from dale of eppllcation submlttel-"Tentative only-must be oonfirmody <br /> ❑CHECK BOX TO EXPEDITE RE EST-$)16 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE/g;7.O`f <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS END USE ONLY <br /> street If 1, Street Name city 0 Unit <br /> i. SptP ��< Ave- - e -- <br /> 2. kt 15. o _ ntt2 <br /> 3. \ <br /> 4. nit 3 <br /> 5. <br /> L7. <br /> ❑Unit S <br /> nk 8 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE$ �., <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT V1.SOUb WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) Ll FOOD FACILITY 4WASTETIRE <br /> UNDERGROUND TANK(MONRORINGIREMOVAL) ❑DOG KENNEL DAIRY <br /> ALARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT POINT <br /> TIERED PERMTITED FACILITY ElMOTELIHOTEL LIMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY•FFODAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type(&)of filos from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. (2091454-0138 or mall 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 END will notify the applicant N any END files exist. An appointment for review will be confirmed approximately ton(1D) <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 END staff may not be Immediately available for review. A new application may be <br /> submitted when the file la available. <br /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$116 deposit prior to review. <br /> S. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> PHO USE DMT <br /> END 4046 SQ7M <br /> 100/L00 z XVj Ld:60 6002/LZ/0l <br />