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05/14/2027 10:35 2094621 STOCKTON PETRO* PAGE 01/01 <br /> `! ���� SAN JOAQUIN COUNTY EHO LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> a{ 1 4 2007 660 E. Main Street,Stockton,CA 95202-3029 <br /> Telephone; (209)468-3420 Pax:(209)464.0138 Web: WWW.gjgov.org/ d <br /> PER.!n l`/SER'/ICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: OA) X4-LlilaTu <br /> ADDRESS: y- -G <br /> PHONE(1): P� PHONE <br /> HONE(c2J):-fIN�E9f3yIAGrELNFC_AY—C:SIM-I-L,qE1:J�--� .Q <br /> f ,Q p- <br /> TENTATIVE*APPOINTMENT DATE; QS gJn A S Cr9lZ Time: <br /> (Please allow 10 business days from date of application submittal.-Tentative only-must be cmdirmad) <br /> In CNECK DOX TO EXPEDITE REQU8� FEE H..L oLY)-REQUEST PROCESSED IN a BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DAA c/ ./S r� 7 <br /> Electronic Information.- ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name City �� C] Unit 1 <br /> 2. ESTI snHuC7 unu z <br /> \ 3. <br /> 4. Units 1 <br /> AMID <br /> Unit 4 <br /> T, <br /> B - - O units <br /> 9. �.. <br /> ---- -- ❑ <br /> units O <br /> f0. <br /> Specific Date Range Of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK 81ST)CLEANUP SrrE(LOP) 13 HOUSING ABATEMENT 0 SOLID WASTE FACILRYIVENIGLE 1 <br /> 1HEn CLEANUP SnE(NON-LOP) 0 FOOD FACILITY 0 WASTE TRE <br /> UNDERGROUND TANK MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> ❑❑❑000 NWARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> ETIEREDPERMnIEDFACILRY EMOTELIHOTEL O PUMPER TRUCKIYARommem Tb0.ETs <br /> 0 TATTOOIBODY PIERCING 0 POOLISPA // El LANG�E APPLICATION PI r <br /> PMEDICAL WASTE FAGILDy „f�,lM1ER(PLEASE SPECIFY) ^�I kl ar' ,Q f' - ,r 3 <br /> WELL AND SEPTIC PERsim RECORDS ARE AVAILABLE FOR RENEW- MONeAY-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(2091484-0138 or mall 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 oxlst. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application, The files will he held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. Ul <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$96.00 deposit prior to review. <br /> EHD USE ONLY <br />