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DATE RECEIVED <br /> n <br /> � SAN JOA <br /> QUIN COUNTY EHD LOG NUMBERt <br /> LA'S ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> `'R. — b L�07 Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/eh <br /> qt 3 <br /> PUBLIC RECORDS RELEASE APPLICATION -SPR <br /> APPLICANT:_ S&7>j G LA---, { BUSINESS/AGENCY:_lebb ye <br /> ADDRESS: '20 Q S I-L 'jerL <br /> 5TIL-'L"`I" I TS L.17v?> f./k -2trc 1 o tq_tom. 11?t-t <br /> PHONE(1):k (- a3 a-�c��o PHONE(2): '6S/-7G&-73I <br /> S/-7G&—7'3g& �&Ql/� FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal-`TentaSve only <br /> y-must be confirmed) <br /> C1 CHECK BOX TO EXPEDITE REQ T-$95.00 EE OR ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT , DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name <br /> --------------- <br /> City )'T `aL ❑ Unit 1 <br /> F, __2 'T 4+u') <br /> 2. �0 ?- 6 Ogg ❑ Unit <br /> 3. <br /> 4. <br /> Unit 3 <br /> 5 <br /> S' ( r?I Unit4 \\ <br /> T. `l1��.'� t. <br /> 8. ❑ Unit 5 <br /> 9. <br /> 10. ❑ Units <br /> Specific Date Range of Information Requested: From (.e Ay 0P F/,TILT%g1 _ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYfVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 13 WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DDG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑ <br /> 13TIERED PERMITTED FACILITY WASTEWATER TREATMENT PLANT <br /> ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑PODLJSPA ❑LAND USE APPLICATION 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)464-0138 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 9174fYJ06 <br />