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DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> -,7 ' ' <br /> D <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3d Floor,Stockton, CA 95202-2708 <br /> 005 Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> 14113 <br /> hLALTH <br /> PUBLIC RECORDS RELEASE APPLICAITON <br /> APPUCANT- narlannt__ t4n I `unao BUSINESS/AGENCY: tctA +on Gro I victi <br /> A <br /> ADDRESS:Aj� ys !L oicy Uma 3 4-t- 44!j 4 SuAf-jrjc . A_�- b1ZSj <br /> I <br /> PHONE(1). Cy Z?Q)4-S I us PHONE(2): FACSIMILE:_I Li 3�0) q5j-3 4 8 <br /> TENTATIVE*APPON47?AENT DATE; Teas: ral <br /> (Please allow lO business days from date of application sulmittal-*Tentadwonly-must be <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS OA <br /> SIGNATURE OF APPLICANT DATE 'I laol C>& <br /> UNIT vis-hisnomUnit 1 0 Unit 2 0 Unit 3 13 Unit 4 13 Unit 5 0 Unit 6 E3 Other(electronicifists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name CRY <br /> ISO �e I <br /> Mack a <br /> 2. jnc�n Lc_r ..0ST !jWV <br /> 4. <br /> s. <br /> 6. <br /> 7. t;Nr nnn <br /> s. <br /> lug <br /> Specific Date Range of Information Requested:From cr),r I', C-S i- to C-In <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> XUNDERGRouND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT C3 Souo WASTE FAoLffyNEHicLE AID <br /> XOTHER CLEANUP BITE(NON-LOP) 0 FOOD FACILITY Cl WASTE TIRE <br /> UNVeRGRoumo TANK(MoNaoRiNGIREmovAL) C3 DOG KENNEL M DAIRY us <br /> AHAZAR13ous WASTE GENERATOR 13 CHrAw-m RANCH 0 WASTEWATER TREATMENT PLANT <br /> E3 TIERED PERMITTED FACILITY C3 MOTEL/HOTEL E3 PUMPER TRucrJYARotC#iEm T(xLEn <br /> C3 TATiroolftDY PIERCING C3 POOLISPA E3 LAND USE APPLICATION SITES <br /> 13 ftoicAL WASTE FACILITY C3 OTHER(PLEASE SPEC" <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MoNvAy-FRIDAY 8:00 Am-5:01)Pm - 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> 11 be processed the next business day. <br /> the EHD.Applications received after 3:00 pm will j <br /> indicatedabove_ Address ranges Will not be accepted-for additional assistance with file addresses,cc it <br /> 2. The EHD will notify the applicant If any EHD files exist. An appointment for review Will be confirm <br /> approximately ton(10)days after receipt of application. The files will be held for a maximum of fi'vVIbusiness <br /> days for review. Appointments 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 <br /> ;S <br /> AL-31W <br /> 11111W <br /> application may be Submitted when the file is available. 4141W <br /> 4. Any file not returned in the same Condition as released will be reorganized by EHD,staff at the expense of the <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> END 49424H <br /> iluffis <br /> L-d 9L17C_L9jV (090 doL:ZL 90 OZ daS <br />