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SAN JOAQUIN COUNTY Sra? -',� EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTN�1 <br /> a :y 2 5 LU IJ 600 East Main St. Stockton, CA 9520 9 1 <br /> g(hone: (209) 468-3420 Fax: (209) 464-0138 We w .sjgov.org/ehd <br /> rER�s')17c;t�'':!hS PUBLIC RECORDS RELEASE APPLICATION <br /> I <br /> APPLICANT: I 1�1� O c' BUSINESSIAGENCY: Z C M <br /> ADDRESS: S h , CZCO CITYISTATE2IP: Cb5f& Mc 36\ Ckq?,(o2 <br /> PHONE(1): oI PHO1N-E(2):S10-&95-GZ( FACSIMILE: <br /> 1- cJlo Z� S- Z(�S(y <br /> TENTATIVE`APPOINTMENT DATE: rAo l J 2 , 2 b) U Time: Pryyl <br /> (Please allow 10 business days from date of application submittal 'Tentative only-must be confirmed) <br /> HECK BOX TO EXPEDITE REQ T-$115 (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUST ESS D YS <br /> SIGNATURE OF APPLICA DATE zS �C <br /> Electronic Information: 3 List XMap- scription:1WilO ✓O C n ii-u" ✓1 3f <br /> FILE ADDRESS I& EHD USE ONLY <br /> Street# Street Name City Unit 1 , <br /> 1. '2_01 `5-tk Sfi VWJ Uhl 62 o co <br /> 2. 9 sp ��� <br /> 14. <br /> Unit 3 <br /> 5. 1 3 3 7 � t h S+ . ,tel �n�� Dr Lo <br /> il <br /> 8. Z23 W� V1 ' Un 'L -6 9 j4 Unit 4 <br /> �. 156 n d . a5 0 (moi <br /> 8. ') 02�. )= , Fro /� *01�e- 3 . � GJ�1ti Q Unit s <br /> 9 3 <br /> 10. <br /> unit BY <br /> Specific Data Range of Information Requested: From Q i to <br /> pp� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES y <br /> Id-UNDERGROUND TANK(UST)CLEANUP SrrE(LOP) ❑HOUSING ABATEMENT r9jSoLjDWAsTEFACILrrYNEHICUE <br /> ;0_11OTHER CLEANUP SITE/(rN��ON-LOP) ❑FOOD FACILITY WASTETIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY r./�l L�/rr✓ <br /> AZARDOUS WASTE GENERATOR [1CHICKEN RANCH RWASTEINATERTREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USEAPPLICATION SITES <br /> ❑ 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 /> 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 /> e UU <br /> o -10t Igo _ N <br /> E tie <br /> co21-Z Oi n lgrou, <br />