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EHO LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 'ENVIRONMENTAL HEALTH DEPARTMENT <br /> A94 2- M008 600 East Main Street, Stockton, CA 95202-3029 <br /> E � �'�jl(' µE-0` lrphorle; (209)488-3420 Fax: (209)464-0138 Web-www"sjgav"or hd <br /> i <br /> P E L PUBLIC RECORDS RELEASE APPLICATION. <br /> APPLICANT: �i MC L- i BUSINESS/AGENGY: f- <br /> ADDRESS,. Ea AO k6 F C'H� v Pp,, City/statalzip ple4544x. <br /> 462" CA <br /> PHONE(t): t l WSJ 7_°� PHdNE(2): FACSIMILE: zCr a 1 Ob <br /> TENTATIVE'APPOIN-rtulENT DATE. `•Z O$ Time: <br /> (Please allow 10 business days from date o applicatlon submittal.-•Tent*+e only-must be conflrmad) <br /> ❑ CHECK BOX TO E)CPEPITE RE4UE3 165 E(C H OR CHECK OH -REQUEST PROCESSED IN 3 USIN98 DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: 0 List[l Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> .street* Street Name GitY p unit'i <br /> r ,e p y�o2 unit 2 <br /> F2. S .e�S ` IL9 S� r ru.c <br /> 3. <br /> Unit 8 <br /> 4. <br /> 7. . Unit 5 .: <br /> g, El Unit B <br /> 10. <br /> e <br /> Li.�/cr' tD <br /> • <br /> Specific Date Range of Information R quested:From !� '�'� ��� .--- --��'r��r�`" ----- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 tiousiNG ARATEMENT El$OLIn WASTE FACILITYNEHICLE <br /> - 14 OTHER CLEANUP SITE(NON-LOP) % _ ❑FOOD FACILITY 12 WASTE 111RE <br /> F5 UNDERGROUND TANK(MONITORING_(REMOVAL)'. - M noG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CKCKEN RANCH 0 WASTEWATER TFMATMENT PLANT <br /> 13 T[EFiEO PERMITTED FACILITY 0 MOTELIHOTEL 173PUHPER TRUCWyAR CHEM ToILETs <br /> ❑TATTGOl13ODY PIERCING ❑POOLTSPA O LAND USE APPLICATION SITES <br /> I F!=AL WASTE FACILITY 1-'3 OTHER(PLEASE SPECIFY] <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE roR REVIEW-MONDAY-FR7bAY$:0O ANS-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 cheeking the appropriate <br /> box(es). At least one file type MUST he selected. rax to 20 4164-0138 or mail to the ad.Omu indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EMD. Applications received after <br /> 3:00 pm will be processed the next buslness 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 reviLlw Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by CHID staff may not be immediately available for review. A new application may be <br /> submitted when the Elle is availablo.. <br /> reorganized b Ei1D staff at the expense of the applicant. <br /> 4. Any file not returned released will be in the same condition as Y <br /> E 'Future file reviews by the same applicant may require a$106 deposit prior to review" <br /> EHD USE ONLY <br /> E <br /> sir <br /> EHD 48-06 B104/08 PUBLIC RECORDS RELEASE APP FORM <br />� I <br />�', Tem ZL0'ON 92TOP9b60ET F N3iNUSH31d NOlAd"l-D ST:LT 903E/i7E/80 F <br />