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uAlt CElVED, - EHp LOG NUMBER <br /> 0 <br /> ENVIRONMENTAL <br /> o � SAN J®AQLTIN C®UICOUNTYRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor, Stockton,CA 95202-2708 <br /> '�Qo6 Telephone:(209)468-3420 Fax: (209)464-0138 Web: <br /> PUBLIC <br /> www.sjov.or <br /> e <br /> hd <br /> Aoki PUBLICRECORDS RELEASE APPLICATION <br /> WO j' BUSINESS/AGENCY:URS <br /> KESS: ?-Z ( YVt -5 t I W <br /> PHONE fl):-0/31/ /31 2 Y 3 -.322,5 PHONE(2), ! l b) 332-- 9c34( FACSIMILE: CL1/F) akZ-1 22.4 f <br /> TENTATIVE*APPOINTMENT DATE:_ //, 2-0vtr Time: 10:4'c A <br /> (Please allow 10 business days from date of applica ion submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE • It rZ j&1QjC <br /> Electronic Information: ❑List❑Map—Description: <br /> FILE ADDRESS EH D USE ONLY <br /> Street Street Name City ❑- Unit 1 . <br /> 1. 4 f Qct. 2. <br /> v r <br /> z. <br /> El Unit 2Ar <br /> 3. „ <br /> 4 <br /> V) <br /> 6• E0 Y"rn U(C�. F I Unit 4 1 <br /> Unit 5 <br /> 8. <br /> QLjj <br /> 100, <br /> --- -9, - --- -- ------ --- <br /> n _ <br /> 10. DEC - 5 20 Unit 6 <br /> Specific Date Range of Information Requested:From ifit) to se,Ft <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYIVEHICLE <br /> 0 OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILnY WASTE TIRE <br /> 13 UNDERGROUND TANK(MONrrORING/REMOVAL) 0 DOG KENNEL 0 DAIRY <br /> 9HAZ.ARDOUS WASTE GENERATOR 0 CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY 13 MOTELJHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO(BopY PIERCING 17 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REvfEw- MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOuDAYS. <br /> 1. Ust up to ten addresses in the space above. Select the types)of files from the fist 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 END will notify the applicant if any END 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 END 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 END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> END USE ONLY <br /> EH0 4W e/13r2M <br /> Z/Z lezeZeeel4 uolleiotljoo SNn Wd £I:ZI Booz/LZ/ll <br />