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Ii a:V-VC 2Vo LV-;-YL rMA - .-•,� <br /> EHD_LUG NUMBER <br /> DATE, RECEIVED, SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL,HEALTH DEPARTMENT <br /> 690 East Main Street,Stockton, CA 95202-3029 <br /> Telikoho06 .(209)468-3420 Fax; (299)464-0138 Weld:www.sjgctv;tlrgJ <br /> Puikic RECORDS RELEASE APPLICATION L■t <br /> .APPLICANTe; rn+i g. L oL neyt g y BUSINEIWAGENCY: ►c"7 !T a S CJ C t J <br /> AOgR& p r'� {; <br /> NE <br /> PtitiNE{tJ C `f PL # : FACSIMIM- <br /> ,`t- .:i 1 tgN`rAT.IV.E"APPOINTMENT DATE: <br /> (Please elldii tert:buslnUS IIys from date of application submittal•`Tentaffvc only-must b .con mad} <br /> © CkiECIrCSOX Tq EliP tMTS.ifE EST- `FII CASH OR Hh Y}•REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATLIRE OF APPUCANT .� � "°"` '"�''-' — DATE <br /> Electronic lnfarmatian: d <br /> List[]Map-Description: ,fig l�0t <br /> i FILE ADDRESS EMD USE ONLY <br /> Street# Street Mame city r 0 Unit l i <br /> 4. ( }✓ W. 6 rr d L i d ., e { <br /> 12, tr rt .. = U 7"ra> -Z 3 6 d [ 1` �C� t�Unit2 <br /> . S /V0 c1 <br /> 4• 2 L4 5-0 Tei s 4-C:.. ��{.- Tt• ..3�5-2-�' <br /> 6. Z 553 lZ r,{: '7'r c4 c 4 d S 7 -e4 ' <br /> I~u Tri f Lr' f 7`rait '1033 <br /> 18- 0 _ Isf Yf� �tt/i t? ��Gc�s r 't "q-S-'s-7 '3'6a<- 'OZ01545 ❑Unity <br /> l <br /> I* rs s GFf b rat%fLt1W..'AZ0ad Trac CLS _ } <br /> 10 ntt'6 <br /> Specific Date Range of Information Requested:From to <br /> y,{ ENVIRONMENTAL HEALTH.DEPARTMENT FILES <br /> F�UIYDERGROFNoTAwK(USTJCLEAwjPSnE(MP); 0HOUSING ABATEMENT )I�SOUDWASTE FAC1UWJVEHCLE <br /> R OTHER CLEANUP SITE(NON-LOP) (3 FOOD FACILITY „$WASTE TARE <br /> RUkDERGROUND TANK f�.(MDNITORIFIGIREMOVALJ 13 D06 KENNEL EI DAIRY <br /> ;Z14AZARDOUS WASTE GENERATOR el CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FAGFLITY Ef M(?TEL fHOTEL C3 PUMPER TRuCt0YARuKlHEM TOILETS <br /> '0 TATToolBpovFIERCM. 13 POOLISPA L7 <br /> LAND USE APPLICATION StfP. <br /> 13 MEDICAL WASTE FACILITY P OTHER(PLE:ASE SPEGI�Y} <br /> WELL AND TIC PERMIT KECOROS ARE AYAILASLE FOR RevIEw-MONDAY-FRIDAY 8:04 AHI-S-WPM-aCLu id tfOLIDAYS. F <br /> 1. Ust 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)484 I30 or mail to the above address ..Address ranges will. <br /> not be accepted-for additionat,a3sistance with file addresses,contact the END. Applications received after 3:00 rim will <br /> be procesrAd the next business.+tl'ay: <br /> 2. The Eli?will notify the applicant It any.END files+exist. An appointment for review wilt he confirmed approximately ten <br /> days*r racaipt of appllcatlon Thee fika .-.utf tlbt held fora maximum of five business days for review. Appointments <br /> should`.be scheduled accprdirigty; <br /> 3.. A file than is actively being worked On by She END staff may not be immediately available for revlew:.A,new poplicattotl <br /> may be submitted Wh011 the file is available. <br /> d, Any file not returned In the same condition as released will be reorganized by END Staff aCthe expense of the aipprteanL <br /> Future file reviowwby the.:same applicant may require a$90:00 deposit prior to review. <br /> E14D'USE ONLY <br /> EN048-Q5101�� P.IA'4WC.1{ffDBRDS R$LEASE APP F9RM ' <br />