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hep. L. iHd I V I 1AM No. 2539 P. 1/2 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENTom% Wo. <br /> 600 East Main Street, Stockton, CA 95202-3029 r <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.or eh/ <br /> v <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT, 4rnnem 15/900- BUSINESSIAGENCY: 5 In. <br /> ADE)RE$S; 1600 .414 J& A, Mde) City/State/Zip LugA cr <br /> PHONE(1): IE(2): FACSIMIL.V-, A7,ZA In:dek <br /> TENTATIVE*APPOINTMENT DATE: 7awg Time: <br /> -14 1`*1 <br /> (Please allow 10 business days from da of appliciftion submittal-*Tentative only-must be confirmed) <br /> C3 CHECK BOX TO EXPEDITE REQUEST-$1q6i FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: 0 List Fj Map-Description:. 77 3 Z 77, 7747— <br /> FILE ADDRESS EHD USE ONLY <br /> Street III Street Name city ® Unit I <br /> MdeV Ave, 6�04*76�,l -0,74I. AloWl-�PI-4 F r, <br /> 3. - W f I , <br /> 2. Z17 g!�jh IIf ❑0 Unit2 <br /> 4- <br /> 6. UnIt4 <br /> 7. <br /> — <br /> ❑ <br /> 8. unit 5 <br /> 9. QA <br /> I I ❑ Unit 6 <br /> 10. 903i 16 equ <br /> Specificateto�gfinfUWiklk T,54&0� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑SOLID WASTE FACiuTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY <br /> 13 WASTE TIRE lNrl qlf 1A <br /> NDERGROUND TANK(MONITORINGt LMOVAL)R 11 DOG KENNEL 0 DAIRY <br /> AZARDOLIS WA$TE GENERATOR 0 CHICKEN RANCH El WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FAcjuTy 13 MOTELIHOTEL C3 PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING 0 PDQUSPAC3_,AND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY ��THER(PLEASE SPECIFY) <br /> A,�W V 4!¢E% <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDA <br /> Y-FRIDAY 8700 Am-5:00pm -EXCLUDING HOLIDAYS. <br /> 1. List up to ton 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 112 the address indicatad ab2me, 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 hold 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 now 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 /> Futurefile reviews by the same applicant may require a$106 deposit prior to review. <br /> EHD USE ONLY <br /> P file e_'1&AL.QALI A A. <br /> K r U T�4W A 15,0, 'PXN <br /> EHD 48-06 8104 PUBLIC RECORDS RELEASE APP FORM <br />