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11/•LU/•LUUS lb:28 San Joaquin County -> 4640138 2 <br /> EHD LOG NUMBER <br /> 4t EHD <br /> SAN JOAQUIN COUNTY <br /> l4Ut� L�O� ENVIRONMENTAL HEALTH DEPARTMENT 400�' <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> E N,V i R(;;_ ;;, (,�T �it�TTelephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/e <br /> Vt- jPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_)]EAR i,.- 12() sir- BUSINESSIAGENCY: <br /> ADDRESS: 44 N . .5r �, �c CITY/STATERIP: <• <br /> �DGcron/ G/a �Svo� <br /> PHONE(1): (n2o i) �� X 70 - PHONE(2): FACSIMILE: Out) q44-g;L <br /> TENTATIVE'APPOINTMENT DATE: D t C 4 aooq Time: 10,111-1 <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQ STT-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /w DATE OoV 1q, 2e)o y <br /> Electronic Information: ❑Llst❑Map-Description: <br /> FILE ADDRESS EHD USE ONLYr� <br /> Street p Street NamoA P N City yN I, ❑Unit 1 <br /> eLuff_&V a -.t to•o 6ruc_14rot4 <br /> 2• 213I1IAPiP40A i'D, 173 Q(o .3rsloclz <br /> 3' <br /> 9 ' C". Hw bfy U(7,p 0-(F t_or'.K.rro�i� Q <�J� Unit <br /> 3 <br /> 6' 3`•i N. (H6-O)eEC LN 0 ayo-o'; LoO IU i Y� <br /> 6. <br /> ¢tit nit <br /> 7, <br /> --- ------- - ❑Unit5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE l <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT Z/ <br /> �TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS I / <br /> ]TATTOO/BODY PIERCING ❑POOLJSPA ❑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 u12 to fen addresses in the space above. Select the type(S)of flies 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 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 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$115 deposit prior to review. <br /> 6. If you need further assistance,please contact Diane Martinez,at(209)468.3426, <br /> EMD USE ONLY AA <br /> EHD 48-06 nw <br /> Ike- <br /> 9127/09 <br />