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Nov 28 05 03:26p Apex 2C- ,67-9668 p.1 <br /> jtECP1It L �� SAN JO.A.QUIN COUNTYLui <br /> �o roc NUMB <br /> ENMONMNTAL HEALTH DEPARTMENT <br /> hov 2� g.Edo 304 East Weber Avenue,3`d Floor,Stockton,CA 95202-2708 U <br /> . Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> N-1 HEALT14 <br /> AWES PUBLIC RECORDS RELEASE APPLICATION <br /> /� <br /> APPUCANT• r a� 1t�''1 SUSINEMAGENCY• Ar-D-or— <br /> ADDREss• Vto p P1 v-t- To r tz e.k OL %.S-3V Z <br /> PHaHt9 W Z `` 4—bb PHONE(2): FAC30a.E: Z` I 6 <br /> TENTATIVE"APPo1NTINEI4T'DATE: f9im1 Z f `ar" Trus: 01 Q <br /> (Please allow 10 business days from dabs of application submittal-'Tergadve only-must be car- rmeM <br /> Cl CHECK Box TO EXPEDITE REQUEST-$93.00 FjEECASH OR CHECK ONLY)-REQUEST PROCESSED IN3 USI DAYS <br /> sIGNATuRE OF APPLICANT I's"���—+/�" DATE 1171 44 <br /> UWT DISTRIBUTION D Unit 1 ❑ Unit 2 D Urrit 3 Una 4 ❑Unit 5 ❑ Unit 5 Cl Other(eleCbvW c lists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> street 0 Street Name City <br /> 215110'L __ -��� LM�4. S}at.IL -► �G J <br /> I7-S S ft e% A SL S tie, 1% Z9 <br /> to S. dS 4 <1L <br /> to 6. (�L45 t' . !r►tiv. L '" C&14-X 35;.17 kD /a9 om4 <br /> 7. x`131 . a tfc. <br /> 3V Y 3.e� tr ►t t Y. � <br /> 1o. <br /> Specific Date Range of Information Requested:From to 1,%/tf t o- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> _50"M MUNDTANK(UST)CLeAWUP StrE(LOP) CI Housnrc AeATemExr 17 SOLID WASTE FAOUTYIVEML.E <br /> ❑arAERCe.EANUp$WE(MM-LOP) ❑F000 FACTIJTY ❑WASTE TUM <br /> 13 UNDE1t=OUND TANK(MoNmmmGmmwAU ❑DOG KENNM ❑DAMY <br /> G HAZARDOUS WASTE GENERATOR D CH cKEN RANCK E3 WAsrewATE1tTMATMENT P{.Aw <br /> CI TIE tED PERmaTeo FAauTr d IIIDTEUHoTEL ❑PUWM TRUpUVARDICIiEM TOREM <br /> CI TATroomoDY Pwj;aNG CI P000SPA CI LAND USE APPuCAum SrsE> <br /> ❑Ii WCAL WASTE FAC9M ❑OTI M(PLEASE SPEClFFIf) <br /> WELL AND SEPTIC PEMr RECONDS ARE AYAItAaLE FOR REVIEW- MWIDAv-FPSDAY 8:00 AM-5:00PM - E)(GLWYAG HOuriAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the fest above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> Indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm wig 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 <br /> approximately ten (10)days after receipt of application- The tiles will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD 49.02-M <br /> 1114105 <br />