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rN EHD LOG NUMBER <br />+,' i A JOAUI COU TY <br />ENVIRONMENTAL HEALTH DEPART qTN$! <br />' r ; U <br />;� 600 East Main St. Stockton, CA 9520 <br />hone: (209) 468-3420 Fax: (209) 464-0138 e `ww.sjgov.org/ehd <br />��.tT!j' <br />���%,"' i --'EP 1("B PUBLIC RECORDS RELEASELIC TI <br />APPLICANT: 1 tU .7( _e C_�` BUSINESSIAGENCY: 1c- I " i <br />ADDRESS: S h ,fit e ZC0ciTYIsTATErziP: CCS 5f t, C 0�'( z <br />PHONE (1): 5 0- (P PHONE (2): 10- CvgS-(p 2(p FACSIMILE: 510 5- 2('05( <br />TENTATIVE" APPOINTMENT DATE: f7r,ao,,jj I `J 2 , 2 b ) U Time: ?A -M <br />(Please allow 10 business days from date ofapplicationub i - Tentative only - must be confirmed) <br />AHECK BOX TO EXPEDITE REQ T - $115 SH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BBU,ST%ESS D YS <br />SIGNATURE OF APPLICA DATEZS <br />Electronic Information: 0 List J, ap - Iyescription: <br />FILE ADDRESS <br />Street # Street Name <br />A1\ A Z 64,k A43?\i ✓N u �`iZ�rI ✓1 <br />EHD USE ONLY <br />City ❑ Unit 1 <br />1. <br />�?_o l <br />5 -ti- 5t. <br />= , i <br />U� T oz �o <br />&5; Unit 2 <br />u� k3 <br />Unit 3 <br />q w,9 1 Unit 4 <br />2. <br />3. <br />4. <br />❑ DOG KENNEL <br />6. <br />❑ CHICKEN RANCH <br />IERED PERMITTED FACILITY <br />Pro n <br />u .+iw � GJ!� l / P [I Unit 5 <br />❑ POOLISPA <br />9. <br />C1 <br />LA PO 000r <br />Unit 6 <br />10. <br />Specific Date Range of information Requested: From <br />t_ -(k V I.i L <br />ENVIRONMENTAL HEALTH DEPART <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />NDERGROUND TANK (MONITORINGIREMOvAL) <br />❑ DOG KENNEL <br />AZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />IERED PERMITTED FACILITY <br />❑ MOTELIHOTEL <br />] TATTOO/BODY PIERCING <br />❑ POOLISPA <br />] MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />W 2-1 'Y_0.S-k3 Infi / <br />RSOLID WASTE FACILITYNEHICLE <br />WAsTETIRE t <br />F1 DAIRY <br />WASTEWATER TREATMENT PLANT r I <br />❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ LAND USE APPLICATION SITES <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 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 />i(/,r7�i % •.rili%�/ ,_rr%l .aJ i -_ / � J �. �7 d � <br />��w <br />IIIINTATIPM <br />'lilt <br />aw <br />T / / 1f <br />