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El CHECK BOX TO EXPEDITE REQUEST - $105 FEE ( <br />SIGNATURE OF APPLICANT <br />ASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />DATE 3/0 c7 <br />-zioVo? <br />HOUSING ABATEMENT <br />OOD FACILITY <br />El DOG KENNEL <br />171 CHICKEN RANCH <br />El MOTEL/HOTEL <br />El POOL/SPA <br />El OTHER (PLEASE SPECIFY) <br />AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00Pm - EXCLUDING HOLIDAYS. <br />JJ NDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON-LOP) <br />MAINDERGROUND TANK (MourroRING/REmovAL) çZ <br />HAZARDOUS WASTE GENERATOR Of, <br />Ig-TIERED PERMITTED FACILITY CX,.. <br />El TAT-too/Boos( PIERCING <br />El MEDICAL WASTE FACILITY <br />WELL AND SEPTIC PERMIT RECORDS ARE <br />la SOLID WASTE FACILITYNEHICLE <br />o WASTE TIRE <br />5ZDAIRY <br />El WASTEWATER TREATMENT PLANT <br />g UMPER TRUCKNARD/CHEM TOILETS <br />LAND USE APPLICATION SITES <br />, q: 11,4I2 wi L v <br />q AringligiArgiffinN- iggi ,. .96O2 0 k-g MOM <br />iffi Mr 1#/),'ilFrAr*i.e ) , - 5 " 6 4 4 I reiii P F. ATM FAM M riir / <br />t / Ji edirAOMMIWOMIE z_:./Z!IWiairirWliF. <br />LICRECORSRELEASE APP FORM <br />DATE RECEIVED END LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1 600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sjgov. <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: f1 /L <br />BUSINESS/AGENCY: 5 I) Pvi <br />ADDRESS: /.toF 1-4,---z_cito , A %lc City/State/Zip 3-foctict)vk 4 sect <br />PHONE (1): 4/ y - 3085-- PHONE (2): FACSIMILE: -2-0 q 44C4 - Zig 5 <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - *Tenta(ive only - must be confirmed) <br />Electronic Information: LII List LI Map - Description: <br />FILE ADDRESS EHD USE ONLY <br />Street # Street Name City Unit 1 <br />/00 LArii 3d )7 ,,no -740 1 VY 5 -Y-' ?•-- 95.=. 6,-. It-o„rJ fICtrq-ekcocr <br /> ? -- We-5 # Th(x)0.-- 1.c...A tiA _ 1_,,,,r mo .09, <br />Unit 3 <br />4. liCM -2- \'Ve 51- tAl)c%..-- V-tx---c-( fA0-4"-fe c- 4- <br />c,(19 <br />Unit 4 <br />6 ' IS Co ›`'5.-- 1/4 e-S 1- %)-qon, 7-e. ,..ci v1/4‘,„(A-1-e c- ri- <br />\?,,4\DO •-s. <br />N.ksi),::),-,_ <br />iv\os .--i'e <br /> ci 2.6,x We 5-IF ViVov% .-0 c,j W 1 NO /Sit 5 <br /> cr --2....._ \,1-4.54- St-cto, :1 0.1 <br />9' '7C, 6 1 Yv ,-,-i-- \L-R,,,--- i-ock.ct_ nit 6 / <br />10. I 0(dAl? td eSt- '1--i>ep.", ILD.J <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />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 />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 />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 />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