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2 <br />DATE RECEIVED <br />SAN .JOAQUIN COUNTY EHD LOG NUM13ER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www,sjg f7 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: I�ICii,"O N Lfi ro BUSINESS/AGENCY: em G60 <br />ADDRESS: d lel, (��jMa 1�1r2 cltyl$tate/ZipK12I Ca- <br />PHONE (1): 9-&4' =SLL- 7 v PHONE (2): �D� 2 ( '2 6 b Y 1�^ <br />FACSIMILLE: Jct �1p 9 <br />TENTATIVE* APPOINTMENT DATE: (4 p" 0 Time: R:50 <br />(Please allow 10 bushass days froAdfcallon submittal - "Tentative only -must ba conSrmed) <br />0 CHECK BOX TO EXPEDITE REQU $1O ECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS BAYS <br />SIGNATURE OF APPLICANT DATE�0- ` %- -Q <br />Electronic Information: <br />Street # <br />Zap 1 '1;m6 <br />❑ List ❑ Map Description: <br />FILE_ ADDRESS <br />Street Name <br />_ �h A Yds <br />'- OC t+O , Ave- <br />Al <br />EHD USE ONLY <br />Unit 9 <br />J�OLib� ti�W/hF ® Unit <br />F( o E 5[ NJ <br />Specific Date Range of Information Requested: From _ aPr bI g J � to <br />we ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />DC-> i o(q Unit <br />q> r LJ Unit 5 <br />l_J Unit 6 <br />UNOEROROUND TANK (UST) CLEANUP SITE (LOP) ❑ H01.131NG ABATEMENT ❑ SOLID WASTE FACILITY/VEHICLE <br />OTHER CLEANUP SITE (NON -LOP) d FOOD FAciuTY 0 WASTE TIRE <br />UNDERGROUND TANK (MONITORING/REMOVAL)Iy ❑ DOO KENNEL d DAIRY <br />Y,HAZARDOUS WASTE GENERATORtK i7 CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOYEL © PUMPER TRUCK/YARD/CHEM TOILETS <br />TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SpzgpY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILAI3LE FOR REVIEW - MONDAY -FRIDAY 8.00 AM,S:OOPM - EXCLUDING HOLIDAYS. <br />I. 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 tate same condition as released will be reorganized by EMD staff at the expense of the applicant. <br />Future fife reviews by the same applicant may require a $105 deposit prior to review. <br />Flan I MV Akn v <br />n V <br />TO 39Vd <br />NOdIdOMN3 <br />SGZT66960Z Tb:TT 8002/LT/ZT <br />