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EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPAR� <br /> U il) 600 East Main St. Stockton, CA 9520 �L9' <br /> L, hone: (209) 468-3420 Fax: (209) 464-0138 We gov.orglehd <br /> pErps �;,;'EP !ICS PUBLIC RECORDS RELEASE APPLICATION n <br /> APPLICANT: I ` •�� e O cI BUSINESSIAGENCY: CL � <br /> ADDRESS: S i I h e_2� CITYISTATEIZIP: COS & PSS CRclZ�Z <br /> PHONE(fl' 5 Q^ tP - of PHONE(2):S)0-�9g5'(o2 �p FACSIMILE: 510—Zq S- 2(p5l( <br /> TENTATIVE"APPOINTMENTDATE: {--r�cko 2 2d U Time: F1rv1 <br /> ,,,...yyy,,, (Please allow 10 business days from date of application ion sUb tal• Tenmom only-must be confirmed) <br /> HECK BOX TO EXPEDITE REQ T-$115 SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUS] dESS D YS <br /> SIGNATURE OF APPLICA DATE Z1 N <br /> Electronic Information: PSList Map- ription: ld Dn'4 3e <br /> FILE ADDRESS e/` EHD USE ONLY <br /> street# Street Name city ❑Unit 1 <br /> �. 20 I S t h Sfi. UJ U`7 C 02 <br /> 2. LQ uS S Unit2 <br /> 3. <br /> 4. �j U I Unita \i <br /> 5. 33 b Sfi . / Qr CO <br /> 6. s - <br /> via-7,1,11 U✓lZ 1/� 9 M�1 Unit4 <br /> 7. OFe4 o LLO� <br /> B. Pro n 'e d . .LO 19 ❑Unit 5 <br /> 9. 23 StoC Sfi. u5T I©Esq oco�y <br /> 70. Units <br /> Specific Date Range of Information Requested: From lJ, i e to ne 1;'Q <br /> NO ENVIRONMENTAL HEALTH DEPARTMENT FILES rrreeeAAA yIn� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT MSOUD WASTE FACIUTYNEHICLE �✓ j% <br /> ;vi UOTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE {,J�y��'I I �• <br /> NOERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> AIARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> Q(U` ❑TATTOoIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> �y��❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> V' 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)4640138 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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EHD USE ONLY <br /> 3 N <br /> UtJ n <br /> o -IO°. Igo N. <br /> ro' E I�9 Z. U c <br /> E ia0�3z2�Z• 0; n �, rarn IIS( <br />