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CAPE RECEIVED • SAN • EHD LOG NUMBER <br /> .�OAQIIIN COUNTY <br /> ENVIRONMENTAL HEALTn DEPARTMENT <br /> 304 East Weber Avenue, 3'd Floor, Stockton, CA 95202-2708 r— !^ <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd 7 0 <br /> PUBLIC RECORDS RELEASE APPLICATION ` T <br /> APPLICANT: 'hrr BUSINESSlAGENCY: �lr fin(y�9PpP7h6! <br /> ADDRESS: .%785 MOrPI(D yCylYtI,U r P/�erant ffil(� tlrn%a ry�f5'>23 T�— <br /> PHONE(1): aS- (00' -4FIO X111 PHONE(2): 9>5 l50 S�iG �Ct/t FACSIMILE: l95-GO? 5 F-2e <br /> TENTATIVE`APPOINTMENT DATE: ld4va 0-7 Time: /O*t( <br /> (Please allow 10 business days from Ldate of app <br /> plication submittal-`Tentalin only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �GA.GGic�. I�Drrt� Lelel DATE .6r`1/ID& <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ until <br /> 1 <br /> SOS CWartGr W l c <br /> z• 3'15 ld 1l W rIIC� C/YL ��, ( , ❑ Unite <br /> -VJ/ C YfWWW <br /> 4. 44YY -d.t'Or LL , CSI - .n:, �Uhit3 <br /> 5. <br /> Unit4 <br /> 7. <br /> ❑ <br /> Unit 5 <br /> 8. <br /> 9. <br /> Unit ti <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> .d UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT J3-;S LID WASTE FACILITYrVEHICLE <br /> OTHER CLEANUP SITE(Nowl.OP) C3 FOOD FACILITY C3 WASTE TIRE <br /> e UNDERGROUNP TANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑DAIRY <br /> ,,d HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY OMOTELfHOYEL ❑PUMPER TRUCK/YARD/CHEM TOILET$ <br /> 0 TATTOOIDODY PIERCING 0 POOL ISPA Cl LAND USE APPLICATION SITES <br /> t7 MEDICAL WASTE FACILITY 0 OYHrR(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORD$AREAVAILABLE FOR REVIEW - MONDAY-rRIDAY e:D0 AMS: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 1209)454-0139 4r 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 H any EHD files exist An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EH0411 a A119l2J�6 <br /> TO 39Vd Hd 9NI833NIDN3 0I13 0ZLVZ099Z6T Z0:60 9002/ZT/ZT <br />