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tHULUV NUMI3tK <br /> ,--p-ATE RECEIVED } SAN JOAQUIN COUNTY <br /> rFA <br /> ENVIRONMENTAL HEALTH DEPARTM rr j <br /> 600 East Main St. Stockton, CA 95202-30 1 < <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: rg/ehU*( <br /> ii <br /> i I . PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: E�b BUSINESSIAGENCY: 1= CSI 9 2-("Z(v <br /> ADDRESS: �2 l�k. . Z 0 0 CITYISTATEIZIP: <br /> PHONE(1): cj - �D - 3 9 PHONE(2): �1 O'S_-(!P20' <br /> P 2�O dp' FACSIMILE:S I D-2cj - 2 6 S(,, <br /> TENTATIVE`APPOINTMENT DATE: rfGin 2 Zo 1 l7 Time: <br /> (Please allow 10 business days from date of applicaU2 submitta `Te tatfve only-must be confirmed) <br /> SACHECK BOX TO EXPEDIT QUE -$115 F H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU INESS AYS <br /> TURE OF APPLICA DATE <br /> Electronic Information: List IlNap- cript n: ;rov,r►^e �� <br /> EHD USE O Y <br /> FILE ADDRESS tom ` <br /> Street# Street Name City ` Unit 1 <br /> 2. )� _�_�.(_�-v��.��.�_ ��' � Unit 2 � <br /> 3. f' <br /> 4. (� Gl Cti V2 I �y+ Unit3 <br /> 5. 3- S DC_ b Av e. <br /> 6. 2 ( w . (�66 Tl <br /> y <br /> Unit 4 <br /> 7. 1-L l Y � <br /> Q <br /> 8. 2Z-7 D 1 • - I ❑Unit s <br /> 9. <br /> 10. ° .. Unit6 / <br /> Specific Date Range of Information Requested: From P (� i� e to <br /> ENVIRONMENTAL ALTH DEPARTMENT FILES <br /> ,!MNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY [:]WASTE TIRE <br /> OTHER <br /> TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEL/HOTEL tjPUMPER TRUCKIYARDICHEMICAL TOILETS <br /> !!!!!!❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AV!IL-ABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <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(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 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 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$115 deposit prior to review. <br /> 5. If you need further assistance, please contact Diane Martinez,at(209)468-3425. <br /> EHO USE ONLY <br /> EHD 48-06 <br /> 8!27!09 <br />