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DATE RECEIVED EHD LOG NUMBER <br /> ��^����D � SAN .IOAQUIN COUNTY �.-� <br /> ((v�," D ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-2708 5 <br /> JUL 2 2 14elephone: (209) 468-3420 Fax: (209)464-0138 Web: WWW sjgov.org/e <br /> ENVIRONMENT HEALTH pUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Gl } LL7: M P C A LN Ae,SBUSINESS/AGENCY: C ,&1 Zk- l NL <br /> ADDRESS: 2-22 W LASpI N!kS ALV CITYISTATE/ZIP: <br /> PHONE (1):4j.3e<[ (,0C) )J5%ONE (2): FACSIMILE:41o9 -5Ss" I cJ l <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$115.00 FEE(CASH O ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2-7-.A UL 2010 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> 1• 1313 ST6Ck rOIV 5t 1.011 tI`� (DZ 1 ) <br /> 2' nit 2 <br /> 3. <br /> 4. <br /> nit 3 <br /> 5. <br /> 6' it 4 <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From (W NI W& 6•t= -TI M to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES r1 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ®SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) DC ❑DOG KENNEL � <br /> �]DAIRY i <br /> HAZARDOUS WASTE GENERATO ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY A0 <br /> �— ❑MOTELIHOTEL PUMPER TRUCKIYARDICHEMICAI TOIL S�1 t�6 <br /> ITATTOOISODY PIERCING ❑POOLISPA. ❑LAND USE APPLICATION SITES 1 <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8:00 Am-5:00PM(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 END 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$115.00 deposit prior to review. <br /> EHD USE ONLY <br /> "*If you need further assistance lease contact Diane Martinez dire�209)468-3425. Thank You*** <br /> 2 - : d Q <br /> - -10 <br /> tom Ws C090D 9 S3 a z� tivJ e. # 4 y"In <br /> C Y, Iq.fq <br />