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DATE RECEIVED EHD LOG NUMPER <br /> • SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 466-3420 Fax: (209)464-0133 Web: www.sjgov.Orgle d ) <br /> 14 <br /> PUBLIC RECORDS <br /> UBLICRECORDS�7RELEASE APPLICATION <br /> APPLICANT' 5yito-1I''C BUSINESS <br /> ADDRESS: r ( C60 Yyld /A'Y: r <br /> k G�C^ 7 <br /> p&'OGI ` q5(PHONE(1): PHONE(Z): <br /> FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: )U0 Time: 5.`0 <br /> (Please allow ten bUSinass day t m date Cf application s midai-'Ten ive only-mus't/br9,confirmed) <br /> �g'P � ffi fortu � Ir, ' � 4uH/PdRT <br /> ❑ CHECK BOX TO EXPEDITE REQU STT}-$98. 0 F E(CASH OR CHECK ONLY)-REQUEST ROC SSED IN TM?.EE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 5L4t'I — DATE S—rs-/F <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit I <br /> 2. t5bg We W 5i rc--Z -Rb I a-3 "Unit 2 <br /> 3. Ln - - �Ljc t - <br /> 4, nit 3 \V <br /> 6. Ito J <br /> 7. <br /> 8. �UnitS <br /> 9. <br /> 10. <br /> ❑unit <br /> Specific Date Range of Information Requested:From J4W1 _ to NqaDOS <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> *UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT ❑SOLID WASTE FACIUTYNEHICLE <br /> 0 OTHER CLEANUP SITE(NON-LOP) M FOOD FACILITY 11 WASTE TIRE <br /> �LINDERGROUND TANK(MOMTORINGIREMOVAL) IIn Dos FENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 173 TIERED PERMnTEO FACILITY MMOTELIHOTEL ❑PUMPERTRUCK/YARDICHEM TOILETS <br /> TATr0016ODY PIERCING 0 POOL/SPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY M OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILADLE FOR REVIEW• MONDAY-FRIDAY 8:00 AM-5:00vm - ExOLUDINO 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(as). At least one file type MUST be selected. Fax to(2091464.0138 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 3:00 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 after receiptof 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 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 /> EHD USE ONLY <br /> EHU 48-M 102W07 PUBLIC RECORDS RELEASEAPP FORM <br /> Ze/Ze 39tVd _EI-1t/0 ON snivais 90099L90E9 9Z :E0 900Z/9T/90 <br />