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tHU LU(i NUMUtK <br /> RECEIVED, ;� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-30 . s <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: w �;,'Org/eh <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 110 iA Tr-e- io BUSINESS/AGENCY: t C 9n2-^(0Z(o <br /> ADDRESS: AL),e_ , cmc Z 0 CITYISTATEIZIP: <br /> PHONE(1): 5" - A-1-6 PHONE(2): S1 FACSIMILE:'51 Q--,2cl.5 - 1(o57(0 <br /> TENTATIVE"APPOINTMENT DATE: Fc', "J, 2 Zo 10 Time: S A vv-\ <br /> (Please allow 10 business days from date of applicatl submitta 'Te t9dve only-must be confirmed) <br /> CHECK BOX TO EXPEDIT QUE $115 F H OR CNECK ONLY)-REQUEST PROCESSED IN 3 BU (NESS AYS <br /> SIG TURE OF APPLICA DATE <br /> Electronic Information: ®.List f ap- cript n: 1W ;�ov,�-►^e v� <br /> FILE ADDRESS 0 #0jEHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> -1. Z30 1 cA-Srh'icJ A,-)e- 'IDD 05? °z <br /> 2 f bc� <br /> _ l l7/1 ���` Unit2 <br /> 3 �!,�A) <br /> . Z S4-reV-�)'1 t: ©E51 <br /> 4. C� fl C� Ve— ( > ' ;, OUnit3 <br /> 6. 21 W . f�a n S �015r ' <br /> Unit <br /> 7. 1 Z r� D <br /> ] � , Q L � / , <br /> 8. 22--7 TW -1 U / Unit 5 <br /> 10. �,n it CO Gfl Units <br /> Specific Date Range of Information Requested: From Q r -e o Dr-ese n-�- I�\ <br /> ENVIRONMENTAL ALTH DEPARTMENT FILES —T <br /> ;UNDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE ���� <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY �N'r <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ASTEWATER TREATMENT PLANT J <br /> J TIERED PERMITTED FACILITY ❑ <br /> MOTEL/HOTEL <br /> LIMPER TRUCKIYARDICHEMICAL TOILET ^ <br /> ❑TATi00IBODY 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-5:00PM(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 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 /> 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. 0 ' <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 /> E ONLY 1�i\ <br /> �- - q q I 5� - 0 +0 � <br /> f, <br /> m •(oOooSl 6s oc9 <br /> E r AkV . E(Z r <br /> EHO,e-06 d i9 1�1o,g. <br /> 21�t� n LD E; <br /> N►a.��t- - �r bli'cdJ �s�4 in`U7 ,f1Ie <br />