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A 8. YH 1': ?4 =^Ir'N yx I NC 066( P. 1%1 <br /> EHD LOG NUMBER <br /> QED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 8 2003 600 East Main Street, Stockton, 95202-3029 y I 5 0 <br /> Telephone: (209)468-3420 Fax: (209)464-013838 w <br /> Web: ww.sjgov.or eh J rY <br /> I '�:Ir IifT HEALTH <br /> ERVIIES y PUBLIC RECORDS RELEASE APPLICATION ''` <br /> APPLICANT 1l`�AS 1`IV�4.. G.CO BUSINESSIAGENCY BnW V1 wtlk VS <br /> ADDRESS. <br /> PHONE(1) PHONE(2): FACSIMILE: ,�M <br /> TENTATIVE'APPOINTMENT DATE: '1 L 7 SSI —Tim: (O: W Q' M. <br /> (Please allow ten busi ays from da of ap lication submittal-'Tentative only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE RE UEST. 98.0 FE (CAS OR CHECK ONLY)-REQUEST PROCESSED IN THRE BU INESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map•D .ption: <br /> FILE ADDRESS EHD USE ONLY <br /> I, Street Street Name city ❑Unit 1 <br /> 3 15 a4i ortk yosew,I i „ LSI oz)"0I SCZ' vtd S�.�f awf° <br /> 0 _ tlltll h (1o"00) g too —H C)-1.):OtS(GZ :kd0 l7UnIt2 <br /> I vvl 'Ll"Y yr vtodb :nd,rr clh� <br /> yN <br /> (TAoerl& I�W�tl�' a OZ ,Ol S162 <br /> (StuclG /l9 Qb; SPC-13-w AwI nit4 <br /> rt Cv�f+Y� AwCDI) : 6, I);Kab j� <br /> _. W- "Mf J �d �n O$I�(,dl^'('/JF� []Units <br /> Fhl WtOl1 /le �b %tw bP' NFA <br /> L�n�s Sf-• j �I VCR no � Ko G(1 /U nk6 <br /> Specific Date Range of Information Requested:From to <br /> L <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> RNDERGROUNDTANK(UST)CLEANUP SUE(LOP) Q HOUSING ABATEMENT "LID WASTE FACILITYNEHIOLE <br /> HER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑WASTE TIRE O <br /> IaUNOERGROUND YANK(MOMTORINGIREMOVAL) 13 DOG KENNEL 13 DAIRY ✓J <br /> IDITIATARDOUS WASTE GENERATOR C3 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> C7 TIERED PERMITTED FACILITY 11 MOTEUHOTEL 13 PUMPER TRUCKIYARDICHEM TOILETS <br /> 13 TATTooIBODY PIERCING 0 POOLISPA El LAND USE APPLICATION SREe <br /> 13 MEDICAL WASTE FACILUY O OTHER(PLEASE SPECIFIC <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-S:OOPM -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. Egxxa 2,1t 12QI)ftAj 98 or mal to the abpye addmili Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD, Applications received after 3:00 pm will <br /> be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointmant for review will be confirmed approximately ten <br /> days after recelpt 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 the EHD staff may not be Immediately available for review. A new application <br /> may be 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHOG 0810n9107 PUBLIC RECORDS RELEASE APP FORM <br />