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DATE RECEIVED � • <br /> SAN JOAQUIN COUNTY EHo LOG NUMBER <br /> ENVIRONMENTAL HEAI,TH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: wr <br /> 61 Z) <br /> or <br /> PUBLIC RECORDS RELEASE APPLI IO <br /> APPLICANT: TX1f4 �fI 1111=,rJ j�y� �� �q <br /> BUSINESS/AGENCY- <br /> ADDRESS:_ �J^� gZ�C�� `�/�, ? <br /> PHONE(1)! c PHONE(2): (Sa(�� r/IZ —Z Z/7 1-R <br /> FACSIMILE: <br /> ni ( <br /> TENTATIVE"APPOINTMENT DATE:�pp � ��nr,�2 <br /> (please allow 10 business days from date ofapplication suhmittal-f 7�fatro OnlTime, /� n g M <br /> Cl CHECK BOX TO EXPEDITE REQUEST-$95.00 EE(CASH OR CHECK ONLY _ y-must be confirmed] I,/ <br /> REQUEST PROCESSED IN 3 BUSINESES S DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS E <br /> _ Street# Street Name HO USE ONLY <br /> 1. rvzCity <br /> 2. Q d1 bWAY S 005�0M) p unit <br /> 3. O Unit x <br /> 4. <br /> Unit 3 <br /> 6. <br /> Unit4 <br /> 7. Ct(J <br /> Unit s <br /> 9 — — <br /> 10. - ❑ unit 6 <br /> Specific Date Range of Information Requested: From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> eUNDERGROUNo TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 <br /> CI QTHER CLEANUP SITE(NON-LOP) (D 501-10 WASTE FACILITYIVEHICLE <br /> UN DERGROUNDTANK(MONITORINGIREMOVAL Q DOG FACILITY ❑WASTE TIRE <br /> DOG KENNEL 2 DAIRY <br /> ❑HAZARDOUS WASTENERATOR ❑CHICKEN RANCH <br /> 0 TIERED PERMITTEDTEDFACILITY 0 WASTEWATER TREATMENT PLANT0 MOTELIHOTEL Q PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑MEWCALWASTATTOO/BODY PIERCING 0 POOL/SPA <br /> O MEDIC.aL WASTE FACILITY O LAND Use APPLICATION SITES <br /> 0 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 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 209 464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with'Ile 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 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 reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EH�98-06 5/182001 <br /> 10 39Vd H3S X171 31ViS NAG-109 6181-998894 89:9T L901/zo/89 <br />