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�eoetR • 4 <br /> B SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> 1 k IV ENVIRONMENTAL HEALTH DEPARTMENT o2 In <br /> SUN 600 East Main St. Stockton, CA 95202-3029 <br /> J)013hone: (209)468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> �T�NM��SERV1GEs PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: &4, a R%IA BUSINESSIAGENCY: eyy,4ov, Spin _�ytr <br /> ADDRESS: 3431 tNLArcg" A,* %Ae, �' CITYISTATEIZIP: 5gj,no �ev�tlA 7\ <br /> PHONE(1): a(o - 07.'36 PHONE(2): FACSIMILE: (c1 'iso-060.5 <br /> TENTA IVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST- 122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT AX—__ __. DATE ( ?o <br /> Electronic information: ❑ List ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street If Skeet Name city It 1 <br /> 2. LASConit2 <br /> v 3. SS n S $. ACSeve A W&g NI) ) o c0/y t . <br /> [)VL 4. $'{-fS nit8 <br /> 5. b2so No (.D/5 r <br /> v' <br /> a. I6 1 S Unit 4 <br /> ±7 _ <br /> p units <br /> nit 8 <br /> Speck Data Range of Information Raquasted: From <br /> to <br /> ENVIRONMENTALDR <br /> HEALTH DEPARTMENT FILER <br /> ,����[[[NOERGROUND TANK(UST)CLEANUP SITE(LOP) ❑�-I HOUSING ABATEMENT S m WASTE FACILITYNEHICLE <br /> HER CLEANUP SITE(NON-LOP) t-J FOOD FACILITY STE TIRE <br /> DERGROUND TANK(MONITORINGIREMOVAL)X ❑DOG KENNEL RY 1 _(� <br /> ARDOUS WA5TE GENERATOR DC ❑CHICKEN RANCH 96STFWATER TREATMENT PLANT �' ,t <br /> TIERED PERMITTED FACILITY 0� ❑,��M+n-TELIHOTEL UMPER TROCKNARDICHEMICAL TOILETS <br /> 0I--��T(A�TTOOIBODY PIERCING tiaPOOLISPA �ND USE APPLICATION SITES <br /> Lq mETICAL 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 uo to ten addresses In the apace above. Select the type(s)of files from the list above by checking the appropriate <br /> Taxies). At least one file type MUST be selected. Fax to(2091 484-0138 or mail to the address Indicated aboyl. Address <br /> ranges will not be accepted-for additional assistance with file addresses, contact the EHD. Applications received after <br /> 8:00 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 file&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 immedlaWy 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$122 deposit prior to review. <br /> END USE ONLY <br /> -I r <br /> IU <br /> (� D <br /> Lill <br /> 45-05 1 <br /> EN <br /> L00/1000 XU8 8C:OL 1107/bL/90 <br />