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•, _ - •"•, • ;J 15 079 7422 ;V 'I/ I <br /> E) ��(D�Tr �}vt?I i 1 EHD LOG NUMBER <br /> ' SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web:14www.sjgov.org/eh ? )`,1�7 t <br /> R,!V1RC1W,fiEa`J i 11-ATH <br /> PER NLTI/S•EE<'' '.CES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Celt L(,f iJ Id <br /> �j � �t� BUSINESS/AGENCY: <br /> ADDRESS: L�j� ()7FFIJA-y ow M. f City/S«t�atee/Zip _Cf'fyf AhFN 1//D,, �1q rn� <br /> PHONE(1): 01(A-Rol-k(ol - PHONE(2); pt(��7��Z?L� FACSIMILE: q; - , 72-2900 <br /> TENTATIVE*APPOINTMENT DATE: S�l - A-+ A Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> 0 CHECK BOX 70 EXPEDITE RE�$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT J DATE _ Io 12-1lodo <br /> Electronic Information: ❑List❑Map- Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name / city <br /> 1. /�-- �dU(S� UC (bJ �J`I�[Q 0��j CE <br /> ❑ Unit1 <br /> 2,1m ( <br /> 2. �. �0� G✓ couloE (16- �f /J Irl F�G� Gyle j,.11 Na�5 ❑ Unit2 <br /> 3. <br /> 4. �A,'1 No�b� / n <br /> 6. `118 E. UIJ UV`' "�6`vo�D/y nit 4 <br /> 7. <br /> El8. (� <br /> Unit 5 \ <br /> 9. <br /> 10. LOUnit 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES file,'5� <br /> -.�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 1:1 SOLID WASTE FACILITYNEHICLE <br /> �y <br /> ANTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY 0 WASTE TIRE � �I'� �. <br /> K-rUNDERG TANK(MONITORING/REMOVAL)O� 0 DOG KENNEL O � <br /> DAIRY ��k <br /> VHAZARDOUS ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> H <br /> TIERED PERMITTED FACILITY04- ❑MOTELIHOTEL d PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PIERCING 0 POOLISPA ❑LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 Am-5:00 pm -EXCLUDING HOLIDAYS. <br /> 1. 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 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> I 3 m <br /> ©0 <br /> EHD 48-06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />