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RECEIVED <br /> DATE�FTljj Z U1 E END LOG NUMBER <br /> L ll�� sr SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEIf ILE C <br /> FP�fif(��JNN EN-AL HEALTH 600 East Main St. Stockton, CA 95202-3029 <br /> Ai rl. +PI�-/SERVIC ,&phone, (209) 468-3420 Fax: (209) 464-0138 Web: wwvv.sjg0v.org/ehd <br /> (p 209.•168,03341) <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Z) BDSINESSIAGENCY. AFL 4-is"I -* _ T <br /> ADDRESS: 2�GU cwt vtc w a T CITYISTATEIZIP: I.c jv-i t` (,-,fe, rA 4�Ib u - <br /> PHONE (1): ( ) ,(�C�`/c� PHONE(2): �g3(�21✓2- ti SS� FACSiMILE: �_... <br /> TENTATIVE"APPOINTMENT DATE' Time; <br /> (Please allow 10 business days from data of application submittal-'Tprttat Ve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQU T-$122 FEE(C4H OR HECK ONLY) REQUEST PROCE5SED IN 3 BUSINE55 DAYS <br /> SIGNATURE OF APPLICANT DATE �}(7_ /1 <br /> Electronic Information: ❑ List❑ Map— Description,, <br /> _ FILE ADDRESS - EMD USE ONLY <br /> Street tY Street Name City <br /> unit 1. <br /> T C w, <br /> J. <br /> 2 Unit 2 <br /> 4 Unit 3 <br /> 6 -- _.._ unit 4 <br /> 7. F. <br /> nit <br /> —.. _._ <br /> _ v d <br /> 10. unit 6 <br /> Specific Date Range of Information Roquewed: From U C.a< Ise r to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ADATEMENI 'dSDLIU WASTE FACILI'I VIVEHICLE <br /> THEIR CLEANUP SITE(NON-LOP) ❑Fool)FACILITY ��ASTE TIRE <br /> ,[/HNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL AIRY <br /> AZARDOUS WASTE GENERATOR CHICKEN RANCH [:]WAS 1 tINATER TREAl'MLNT PLANT <br /> 71 TIERED PERMITTED FACILITY ❑MOTELIHOTEL Ej PUMPER TRUCKIYARU/CHEMICAL Toa.(-1-5 <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA r[E LAND USE APPLICATION SII ES <br /> FZMEDICAL WASTE FACILITY OTHER(PLCASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE:AVAILABLE FOR REVIEW: MONDAY-FRIDAY$;00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List kip to tend dresses in the space above. Select the type($)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 indieatad above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,^contact the LHP. 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 $122 deposit prior to review. <br /> rHO USE ONI.v _ <br /> t'HD as.oe <br /> _. vrtserlo <br /> TO/T0 39Vd S1Nvi-inSNOO I3V 6609912L9Z6 b0 TT TTOZ/ZZ/60 <br />