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DATE RECEIVED ti8SOON NV b ZIOZ 8nr:►-awII paA1 ;0 <br /> RECEIVED <br /> SAN .)OAQUiN COuty I 'r v' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> AL 1 201Z Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL <br /> EALTH <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: , s BUSINESS/AGENCY: Ale�nS on L n n'7441-zi <br /> ADDRESS: 'IS'O f PC --'jr S9� i-IQ CITYISTATEIZIP: Sg <br /> PHONE(1): Aoj--76�-_761Ga PHONE (2): FACSIMILE:_ DD j-X57-ZZZ/ <br /> TENTATIVE''APPOINTMENT DATE: T"I Time: Joao 4, , <br /> (Please allow 10 business days from date of plica ion submittal-`Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$12 EE(C CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ` DATE I// <br /> Electronic Information: ❑ List ❑ Map- Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Streets Street Name City ❑Unit 1 <br /> 2. ❑Unit 2 <br /> 3. <br /> 4. Unit 3 <br /> 5. ,2 Fi S l r2 <br /> 6. �ls� �-- [('�Jnit4 <br /> 7. <br /> $, ❑Unit 5 <br /> 9. <br /> 10. ED] Unit 6 t <br /> Specific Date Range of Information Requested: From l7 to ✓PS�+,?� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING A13ATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ®'OTHER CLEANUP SITE(NON•LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ,K]UNDERGROUND TANK(MONITORINGlRELiovAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUM PER TRU CKNARDICHEM ICAL TOILETS <br /> ❑TATTooIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERIAT 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$125 deposit prior to review. <br /> I <br /> EHD 4e-06 eruct <br /> I <br /> L'd L7,7,ZL9E60Z UOSIeN 13ZZ:60 Z! 21. I'M[ <br />