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V J, �I, cvVC 1VG Lv: YL CNA Wloot(��t <br />DATE RECEIVED EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />APPLICANT: <br />ADDRESS: <br />ENVIRONMENTAL HEALTH DEPARTMENT Smsiii-S/ <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax; (209) 464-0138 Web: www.sigov.org/ <br />PUBLIC RECORDS RELEASE APPLICATION <br />rg <br />M <br />PHONE (1): _ '1 t f1 - f -> 5-'t � '/ n PHONE (2): FACSIMILE: <br />`Lt4- lb'I TENTATIVE' APPOINTMENT DATE: (0 _Tirne: /-�41•VI <br />(Please allow ten business days from date of app6DaU9n submittal -•Tentative only- must be co med) <br />a <br />ME <br />17 CHECK BOX TO EXPEDITE REQUEST -599. CASH OR CHF; yJ Yl�REQUEST PROCESSED IN THREE BUSINESS DAYS <br />SIGNATURE OF APPLICANT.. IC <\%/`���L DATE__ 5 I48 <br />Electronic Information: XrList ❑ Map - Description: (S t> P_ 2 acl'c, 5 MG to <br />0 HOUSING ABATEMENT <br />_ <br />FILE ADDRESS <br />OTHER CLEANUP SITE (NON -LOP) <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />EMD USE ONLY <br />I. <br />Streets <br />Street Name <br />City <br />�ruc <br />Trac 9�5-37i <br />TracL4r1S <br />• ( �Lpl„rf) <br />t (rnl �i S7\' <br />✓40 ounit 2 <br />V00 z i Htuo,):D-& -'s <br />z%Q)s <br />W, rGh{ i c enact - <br />�_ <br />_ . <br />f u <br />3. <br />3t7(0 <br />rI <br />4 <br />L45 - )J <br />TG E, Zok. <br />Trq r q 4 <br />Trat <br />114(LL) : rFw(oz),e� Irl as <br />P <br />5•W• <br />Grc{ttE L;ne Rood <br />6• <br />2. 553 <br />_TG s! � 2 c( <br />' T rct c <br />9S3 <br />VU4nfr nit4 <br />t0 <br />mvlt Li RonA <br />8- <br />10. <br />310 <br />r3 �Fso <br />CUN{ II`ltQ RoacPNa <br />_.W . rat,{ :1e. Road <br />I <br />�Trac <br />rl rlct r153�� <br />T'rat Crs30._ <br />liIAT 61 )e (�Sa units <br />0 <br />nit 6 <br />• <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILE <br />S <br />RI UNDERGROUND TANK (UST) CLEANUP SITE(LOP) <br />0 HOUSING ABATEMENT <br />) SOUE WASTE FACILITYMFHICLE <br />OTHER CLEANUP SITE (NON -LOP) <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />E7 FOOD FACILITY <br />O Doc KENNEL <br />XrWASTE TIRE <br />13 DAIRY <br />1 <br />j <br />XHAIARDOUSWASTEGENERATOR <br />TPERMITTED FACILITY <br />0TATTOWBODYPIERCING <br />13 CHICKEN RANCH <br />❑ MO EL <br />❑ peoILISPA <br />❑ WASTEWATER TREATMENT PLANT <br />0 PUMPERARD(CHEM TOILET <br />0 LANG USE APPucATR�v <br />❑ MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 9:00 AM-S:DOPM - EXCLUDING HOLIDAYS, <br />1. List up to ten addresses In the space above. Select the type(s) of files from the listabove by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (209) 484.0138 or mail to the above address. Address ranges will <br />not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after 300 pm will <br />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 <br />days atter 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. Afile 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 />EHO USE ONLY <br />