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9 <br />11/'LU/ZUUU 15:28 San Joaquin County -> 4640138 2 <br />I►urp 14- �Ll SAN ,IOAQUIN COUNTY EHD LOG NUMBER <br />t4u V nnoo ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-3029 nn <br />7 <br />E(�31/E���'►V('.%`�1Rd T HPALT T[ flephone: (209) 468.3420 Fax: (209) 464.0138 Web: www.sigov.org/e <br />P`RIM, Ilr/vt'a'!v 3 PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: DEAR1r, pn'w�" BUSINESSIAGENCY: <br />ADDRESS: _44- N. _5'�>✓ �vra�lct�LL +! 3v CITYISTATE/ZIP: <' <br />_7DN <br />PHONE (1): (�2oci) 4 (� L� �70� PHONE (2): FACSIMILE: (,Z(..)t) q44 -g5/_5 <br />TENTATIVE" APPOINTMENT DATE: D (c Time: / v; cx> <br />(Please allow 10 buslnoss days from date of application submittal-'TenfaUve only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQ STT�- $115 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE p4ov l q, .ion y <br />Electronic Information: 0 List 0 Map - Description: <br />FILE ADDRESS EHD USE ONLY <br />Street p Street Name A F N City L� /� ❑ Unit 1 <br />1' <br />)70�1 _. <br />courirPy cru I}a -.t+u o <br />5roc- KTnn1 Zt� 3 <br />O t ?� <br />2. <br />213 <br />I'. NA�1PA5A PD, 173.0(0 3r <br />3. <br />���$ <br />Errc. , ),r -ti) N 045 •130-i <br />Lo U+ ®(��,,V)) vjt� <br />I_neKrr-'or o nit <br />TATTOOIBODY PIERCING <br />❑ MEDICAL WASTE FACILITY <br />13175 <br />G. Hw C)17,0 A-tt <br />5. <br />3; <br />N.CNG._oK6f LN D -011 <br />LoD U <br />o P I 7 nit <br />6. <br />7, <br />8. <br />--.-- -- <br />_ ❑ Unit 5 <br />9. <br />10. <br />❑ Unit $ <br />Specific Data Range of Information Requested: From <br />I ( i l AhOn <br />to (' (A iep 1= Al I_ <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />® UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT <br />k <br />❑ SOLID WASTE FACILITYNEHICLE I( <br />OTHER CLEANUP SITE (NON -LOP) <br />® UNDERGROUND TANK (MONITORINGIREMOVAL) <br />0 FOOD FACILITY <br />0 DOG KENNEL <br />❑ WASTE TIRE j <br />❑ DAIRY <br />® HAZARDOUS WASTE GENERATOR <br />TIERED PERMITTED <br />0 CHICKEN RANCH <br />0 WASTEWATER TREATMENT PLANT J �f <br />FACILITY <br />❑ MOTEUHOTEL <br />❑ PUMPER TRUCKIYARDICHEMiCAL TOILETS <br />TATTOOIBODY PIERCING <br />❑ MEDICAL WASTE FACILITY <br />El POOUSPA <br />0 OTHER (PLEASE SPECIFY) <br />0 LAND USE APPLICATION SiTES <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-S:ODPM (EXCLUDING HOLIDAYS) <br />1. List up to ten addresses in the space above. Select the type(s) of flies 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 Marti t 209 "CQ 'fA°° <br />, nez, a ( ) <br />