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i <br /> DATE RECEIVES EH13 LOG NUMBER <br /> JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 500 East.Mair Street, Stockton, CA 95202-3029 <br /> Telephone, (209)458-3420 Fax: (209)464-0138 Web: www.sjgov, d <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: (� <br /> ADDRESS: d Noc�` W1,trvL" Gity/StstelTip (Z02, C­ EE7 J <br /> PHONE(t): . _ZO� 11C �OQ� PHONE(2): ZO°( 3Z1 ZC F FACSIMILE, 8 2-- 1q- p <br /> TENTATIVE*APPOINTMENT DATE. 12- -O Tima: F-3G - <br /> (Please RIIOW 10 business days from data o application submittal-"Tentative only-must be confirmed)- <br /> CHECK BOX TO EXPEDIT RECIVE 05 F A R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE � �g <br /> Electronic information: ❑List[] Map–IASCription: <br /> FILE ADDRESS EHD USE ONLY <br /> Stroat# (IStreet Name �j City <br /> ! I. S 0''4 aG[Dr ►CZ ❑ Unit' <br /> c0 5; cqW ❑ unit r <br /> —7 3. L0 �- A te., ? Da a, t <br /> 4. a oS. <br /> ti. - 1 i ft�j Unit 4 <br /> 7. <br /> 8 ❑ Unit 5 <br /> 9. - - <br /> 10. ❑ Unit G <br /> Specific Date Range of Information Requested:From _ to dA_i <br /> ENVIRONMENTAL HEALTH OEPARTMENT FILES A0 5 � <br /> f�UNDERGROUNo TANK(UST)CLEANUP SITE(LOP) d HoUSING ASATLM ENT 0 SOLID WASTE FAmLITYIVENICLE <br /> iWOTHER CLEANUP 517E(NON-LOP) ❑FooD FAcILITY 0 WASTE TIRE �' I'� _7 <br /> If UNDERGROUND TANK(MONITORINGIREMOVAL)PC t7 Dou KENNEL Q DAIRY. <br /> WHAZARDOUS WASTE GENERATOR x 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT i I Flo <br /> 17 TIERED PERMITTED FACILITY ❑MOTELfHOTEL 0 PUMPER TRucK1YAR0/CHEfA TOILETS <br /> 0 TATToo/BODY PIERCING Cl PODLISPA M LAND Usr APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:110PM • EXCLUDING HOLIDAYS.-�^-- <br /> 1. List up to ten addresses in the space alcove, Select the type(s)of files from the list above by Chocking 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. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> Act 10-�Z TWjj Ar1, <br /> EHD 48.05 8/04108 PUBLIC RECORDS RELEASE APP FARM <br /> Z9 719dd NOdIdI339IJ3 56LT6GSG0Z TP:TT BOOZILT/ZT <br />