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JAN-21-1996 11:07 P.02/02 <br /> DATE RECEIVED .. 1.00 EHD LOG NUMBER <br /> RECEIVE® SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> OCT 201 1868 East Hazelton Avenue, Stockton, CA 95205-6232 li <br /> elephone: (209)46873420 Fax: (209)464-0138 Web: www.sjgov,orglehd <br /> EMIIRONMENTALHEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> —=EE= <br /> 1=r <br /> S <br /> APPLICANT: Ab\Dy PP BUSINESS/AGENCY: ACJLC^o2S <br /> ADDRESS: 105 e°\ C:'to-\iae-\ 'pc, 3}e. \00_ CITYISTATEOP: [3c:a�E�� t S$\\Lb <br /> PHONE(1): PHONE (2): FACSIMILE: Bea- 22_F`t'- <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of applicaBon 5ubmltrol-•Tanfarlve only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE \01-X I \-31, <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> ,y� See"# Street Name City ❑ Tgt 1 I i J <br /> ll` 1. Ay4`i� co�P <br /> �\I 2. _. Unk 2 <br /> 3. <br /> 4. <br /> S. l <br /> _ r5 <br /> _- <br /> 8. .., PUnk4 <br /> 7. <br /> 8. __ .. .. Unit5 <br /> 9. <br /> 10. Unit" <br /> Specific Date Range of Information Requested: From \ l 99 3 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �-y <br /> l_f UNDFAGROUNO TANK(UST)CLEANUP SITE(LOP) [3 MEDICAL WASTE FACILITY LTJ SOLID WASTE FRCP ITYNEHICLE �I <br /> HER CLEANUP SITE(NON•LOP) ❑HOUSING ABATEMENT R1nASTE TIRE u(II. <br /> RNOERGROUNO TANK(MONITORINoIREMOVAL) ElFOOD FACILITY ❑DAIRY Icy 5 <br /> urABOVEGROUND TANK ❑CHICKEN RANCH)DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> [�'�,{t�'—'ARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> IpTERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOMODY PIERCING tRfOMPLAINTIRESPONSE RECORDS ❑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(2091464-038 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 Flies 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$125 deposit prior to review, —BOXED AREA•END USE ONLY••• <br /> a <br /> T-1 Rnrnrrl,n rlrnvirferf.(Tv Cfgff.PPR Cg mnlitfd:'stuff Name: ' <br /> Received TimerOct. 2. -2013-11 .46AN°�No. 4197 <br /> TOTAL P.02 <br />