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.v %. LVV) Y. V r LL1Y 1 L_V L RU. I)L`t I . I <br /> LOD Lug INJMBER <br /> SAN JOAQUIN COUNTY <br /> MIRONMENTAL HEALTH DEPARTMEM <br /> NUV 0 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wv Sjgov.or <br /> ENVIRONMENT HEALTfi PUBLIC RECORDS RELEASE APPLICATION <br /> P /At -- <br /> APPLICANT Ul _ BUSINESSIAG;ENCY: Yet'M"G1C��'Gf1N' <br /> ADORE! [7 �n1� chN7 .V IP <br /> ylstatelzlp 1 <br /> q�0lir r �2� <br /> PRONE(1): _31t¢_I'i0 ( . PHONE <br /> ,� ,, FACSIMILE: QI - --701'5 <br /> TENTATIVE'APPOINTMENT DATE: 1111N L f AM �IbV "ITimel <br /> (Please allow 10 business days from date of applIedtlon submittal--7'antativa only-must be confirmed) <br /> E3 CHECK BOX TO EXPEDITE qr9QU�EST-$$1L <br /> 105 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED INS BUSINESS DAYS <br /> SIGNATURE OF APPLICANT SN/ DATE 1O I2� 'Oq <br /> Electronic Information: ❑List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street A Streat Nam® CrI <br /> 2. <br /> 3. 1qqw"Apir (j\ <br /> 4. <br /> UnItAl <br /> 7. J j ❑ Units <br /> a. ] <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From ALL to <br /> ENVIRONMENTAL HEALTH DEPARTMENT k 3`� ^� <br /> -ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT O SOLID WASTE FACILITYNEHICLE <br /> :R CLEANUP SITE(NON•LOP) ❑FOOD FACILITY OWASTE TIRE \ <br /> NOERGROUND TANK(MONITORINaIREMOVAL) 11 Doo KENNEL dDAIRY <br /> 'AZARDDUS WASTE GENERATOR M CHICKEN RANCH 0 W EWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY C3 MOTEUHOTEL MPER TRUCK/YARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING C3 POOUSPA LAND USE APPLICATION SITES <br /> l]MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW • MONDAY-FRIDAY$1.00 AM• N - EXCLUDINGtt.QJZAY6- <br /> 1. List up to ten addresses In the space above. Select the typo($)of files from the list above by checking the ap proprlate <br /> boxes). At least one file type MUST be selected. FaX to 1209)4 0138 or mall to the address Indicated above Address <br /> ranges will not be accepted—for additional assistance with fllo 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 END 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-0e 9104108 PUBLIC RECORDS RELEASE APP FORM <br />