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EHD LOG NUMBER <br /> i - SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTINr <br /> 600 East Main St. Stockton, CA 9524 } 9 <br /> hone. (209) 468-3420 Fax: (209) 464-0138 We �.v -sjgov.orglehd <br /> ` :`ifS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: A y y _P_1 C) ' BUSINESSIAGENCY: <br /> ADDRESS: c <br /> S Vl +C ZCOCITYISTATE2iP:_CO5f t,, ���0,.C kgZ(P Z <br /> PHONE(1): Cj Q-- LQ PHONE (2�: ����o��-(c �p FACSIMILE: 5 0~Z 5' 2(P5� <br /> TENTATIVE*APPOINTMENT DATE: f--riAa Z 2 b o Time: <br /> (Please allow 10 business days from date of-application sub i-'Tentative only-must be confirmed) <br /> HECK BOX TO EXPEDITE REQ T-$115 SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSI ESS D YS <br /> SIGNATURE Of APPLICA DATE Z I� <br /> Electronic Information: 2 Listj,Map— scription: t tb rr D n� �r ✓1 �� <br /> FILE ADDR' e� j EHD USE ONLY <br /> Street i* Street Name City ❑unit 1 <br /> h Sfi, `7T oZ No b _`. <br /> ` ,... n '4 <br /> 2. — L �uS , Ht;�•N unit 2 <br /> 3. <br /> —_ U L ' unit 3 <br /> 5. 3 3 �� <br /> (i. �GL ►rl Z t0 �� Unit4 <br /> s. o2Z, ��o n e d . u ->�w co�y ❑unit 3 <br /> 9. Sfi. U5 T r 065; o Gory <br /> 10, <br /> Unit 6 <br /> Specific Date Range of Information Requested: From 777= to <br /> 11-0 ENVIRONMENTAL HEALTH DEPARTMENT FILES �,[� <br /> tfUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILFTYNEH{CLE <br /> ;y"41WTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIREDERGROUND TANK(MONITORINGIREMOVAL) ElDOG KENNEL [jDAIRY ��FAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT ERED PEPMTTTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> �' ❑TAT1001BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:oOPM(EXCLUDING HOLIDAYS) <br /> 01- 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 behold 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 Martinez,at(209)468-3425. <br /> EHD USE ONLY <br /> 3 N <br /> e G1� f11 n <br /> 0 J "20 �U <br /> 1 :5QZ , <br /> LHP 46T�(��Z2Z• T <br />