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EO•d _1d101 • f <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> A FR 2 1 200Telephone; (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org d /6 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATIONIs <br /> 6. 1/� 111 <br /> APPLICANT: 1 Qr 41/�0 �•�� BUSINESS/AGENCY: 6VLTtW / <br /> ADDRESS: , X� ��r�T,.� � bmf 1'1trC� Re A City/state/zip <br /> r";1�� C"" 5�bb <br /> PHONS(1): ZoDI 6N '3GoA PHONE(21: ?.CA 3 ZI••Z�r FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: /1'f2g A Time: T Jf <br /> (Please allow 10 business days from date of applicatloyn submittal--Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 4/'ZI- ly9 <br /> Electronic Information: ❑ List[]Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street ft Street Nam* City ❑ Unit <br /> f2. <br /> rC�J/o1` . F- P --- <br /> (az o�5 vo w(5Q <br /> 3 2C7 W tA+l AIS <br /> O n <br /> \ <br /> Unit <br /> 4- A �) <br /> 5. 190 l WeAinylol� <br /> 6. Arv),Mof <br /> �• + �__.__... __...1KtL I 1 ❑ Unit 6 <br /> 8. <br /> 9. ,....._..--- ❑ Unitj <br /> Specific Date Range of Information Requested:From eor(IC!)" to /l,;C,} /1461A} (� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT D SOLID WASTE FACILITY/VEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 0 WASTE TIRE <br /> 91�.�yUJJJ)NDERGROUND TANK(MONITORINGIREMOVAL) D OOG KENNEL ❑DAIRY <br /> $211AZARDOUS WASTE GENERATOR D CHICKEN RANCH D WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY D MOTELIHOTEL D PUMPERTRUCIOYARD/CHEM TOILETS <br /> D TATTOOIBODY PIERCING ❑POOLISPA In LAND USE APPLICATION SITES <br /> 173 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVA4ARLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-6:00PM - 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(20&)464-0138 or mall 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 tiles will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 2. 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> I - I-2 <br /> in <br /> vJ I D <br /> 0 it <br /> d 303 <br /> EHD 48-06 8/04106 PUBLIC RECORDS RELEASE APP FORM <br /> 20/?O'd 6610 998 9Z6 T aaldd0d800NI 03EK3 ££:9T 600E-R-JdH <br />