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:7 DATE RECEIVED SAN JOAQUIN COUNTY END LOCA NUMBER ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjg 414 0 �Z PUBLIC RECORDS RELEASE APPLICATION r APPLICANT: P IGii'R � o N Lj-"o BUSINESS/AGENCY: el\j CtFU ADDRESS: _. S -M I, W1144" few, _ Clty/$tate/Zip 0,;%"n 00- I's- '„ ! PHONE (1): 264 b� GF___- 'I � 04 PHONE (2): 7,04 FACSIMILE: TENTATIVE*APPOINTMENT BATE: (Z' , v -� Q Time: _ 0 :,�0 (Please allow 10 buslna55 days from date a plicatlan Submittal - "Tentative only -must be confirmed) I7 CHECK BOX TO EXPEDITE- REQU $105 F C HO ECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE Z- l -;L Q UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY/VEHICLE OTHER CLEANUP SITE (NON -LOP) d FOOD FACILITY ❑ WASTE TIRE UNDERGROUND TANK (MONITORING/REMOVAL)( Cl Doo KENNEL ❑ DAIRY HAZARDOUS WASTE GENERATORN C3CHICKEN RANCH a WASTEWATER TREATMENT PLANT ❑ TIERED PERMITTED FACIL ITYY ❑ MOTEUHOTeL PUMPER TRUCKIYARDICHEM TOILETS d TATTOO/BODY PIERCING ❑ POOL ISPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLLASE SP=FY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILA13LE FOR REVIEW - MDNOAY-FRIDAY 8:00 AMA5:00PM - EXCLUDING HOLIDAYS. 1. List Up to ten addresses In the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mall to the address Indicated above Address ranges will not be accepted , for additional assistance with file addresses. contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The I_HD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of applieotion. The files will be held for a maximum Of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be submitted when the file Is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $105 deposit prior to review. FMn i ICC ANI v T9 3DVd NOdId=N3 56LTHSHZ Tb:TT 8092/LT/ZT Electronic Information: ❑ List ❑ Map 4 Description: Street # FILE ADDRESS Street Name LEHD USE ONLY 1• q City �U u h � Y� ��' � Q Unit 1 iJ Unit 2 3. Lcot, 4 Z D S �S�Ocu+o^-, 'Ave—U y �� z) D E S[,vJ GiY� 2�Fj Unit -3 5. Qin �� I 6. U E U5 CC> Ajo(o(yQ Unit 7. 8. 33� �� eZ) � unit S L us s 10. 23 / Q Unit 6 Specific Date Range of Information Requested: Prom GRP b, 1 to pri?s en ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY/VEHICLE OTHER CLEANUP SITE (NON -LOP) d FOOD FACILITY ❑ WASTE TIRE UNDERGROUND TANK (MONITORING/REMOVAL)( Cl Doo KENNEL ❑ DAIRY HAZARDOUS WASTE GENERATORN C3CHICKEN RANCH a WASTEWATER TREATMENT PLANT ❑ TIERED PERMITTED FACIL ITYY ❑ MOTEUHOTeL PUMPER TRUCKIYARDICHEM TOILETS d TATTOO/BODY PIERCING ❑ POOL ISPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLLASE SP=FY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILA13LE FOR REVIEW - MDNOAY-FRIDAY 8:00 AMA5:00PM - EXCLUDING HOLIDAYS. 1. List Up to ten addresses In the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mall to the address Indicated above Address ranges will not be accepted , for additional assistance with file addresses. contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The I_HD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of applieotion. The files will be held for a maximum Of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be submitted when the file Is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $105 deposit prior to review. FMn i ICC ANI v T9 3DVd NOdId=N3 56LTHSHZ Tb:TT 8092/LT/ZT