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efit)LUG NUMtStK <br /> VF-REeE-IV_-V)J_ ;;_" ij`' SAN JOAQUIN COUNTY <br /> U <br /> E <br /> ENVIRONMENTALDEP WIT <br /> HEALTH A <br /> 600 East Main St. Stockton, CA 952030j.hone: rglehc*, <br /> (209) 468-3420 Fax: (209) 464-01313 Web; f <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINES"SIAGENCY: 9 2-(o z(0 <br /> APPLICANT: <br /> ADDRESS: <br /> Zoo CITYISTATPJZIP: <br /> - t. 6 <br /> —69 PHONE(2): �51 0-01�- 2�7g' FACSIMILE.510-295_::� <br /> PHONE(i): n 1.0-9 <br /> 6, <br /> - vv-\ <br /> TENTATIVE*APPOINTMENT DATE: lt2 L0 � 0Time:_ <br /> (Pidaso allow 10 business days from date of applicatl submittaU1-Teritove only-must be confirmed) <br /> 1 <br /> CHECK Box TO EXPEDIT QUE -$115 F OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS)DAYS <br /> SIA0 T, URE OF APPLIC DATE <br /> FE71 16 <br /> tronic Information: &List Map—(6�4cript Nkt Cr)N, IS <br /> SS Y <br /> FILE ADDRESS I"$#I EHD USE 0 <br /> Street# Street Name city Unit i <br /> F, C) S+ C%_y1 L) <br /> _0 <br /> 1 C) N KA 01, Ir 04nit 2 1' <br /> C 3. <br /> 'U,A <br /> 4. a Ck Unita <br /> 6. NA&',r) vrunit4 <br /> �Ve <br /> 7. <br /> 8. `zz,7 C)o 44EtMpo t+Uj 0 Unit 5 <br /> 9 -3 3 -A <br /> . klunit 6- <br /> Specific Date Range of Information Requested: From e I i <,S7, to Dr)p_se K) <br /> ENVIRONMENTAL FIFEALTH DEPARTMENT FILES I <br /> OTHER <br /> TANK(UST)CLEANUP SITE(LOP) [I HOUSING ABATEMENT 2rSOLID WASTE FACiLiTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> NBERGROUND TANK(MONITORINGIREMOVAL) El DOG,KENNEL ❑DAIRY <br /> HAZARDOUS WA Cli CKEN RANCH <br /> WASTE GENERATOR I ASTEwATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY El MOTEL/HOTEL UNtPER TRUCK[YARDICHEMICAL TOILETS <br /> F1 TATTOO/BODY PIERCING El 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-6:00PM(EXCLUDING HOLIDAYS) <br /> 7. List un to ten addresses in the space above. Select the typo(s)of files fr:b' m the'list above by checking the appropriate <br /> bok(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. ii <br /> 2. The EHD will notify the applicant if any EHD files exist An appointment for review will be Confirmed approximately ten(I o) <br /> days after receipt of application. The files will be held for a maximum of ifive 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 irnmediatIly available for review. A now application may be <br /> submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganizedi by EHD staff at the expense Of the applicant. <br /> Future file reviews by the same applicant may require a <br /> $115 deposit prior to review. <br /> 5. If you need further assistance, please contact Diane Martinez,at(209)468-3425. <br /> END USE ONLY <br /> EHD 48-06 <br /> a. <br /> 8127109 <br />