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1 D `E RECEIVFb <br /> 1 <br /> SAN JOAQUIN COUNTY END i_Oa NUMBl'R <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St- Stockton, CA 95202-3029 <br /> Telephone: (249) 468-3420 Fast: (209)464-013B Web: www,sjgov-arg/e ci <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> ��_ i.�. _ r u rNles iAGEnlcY: ( - <br /> AOpFtESS: CJ Al. OITYISTATEIZIP: r <br /> PHONE (1): ��u� PHONE(2): '1001. 31-1 T ,Cf- FAGSIM1LE:__ '4 " � �m 2489 <br /> TENTATIVE"APPOINTMENT DATE; "L-' ice' Time: 8:3A) <br /> (Please allow 10 Farasin®sa days from data of application submlttal-*tentative only-must be confirmed) <br /> Q <br /> CHECK BOX TO EXPEDITE RFQ T--$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 5USINESS DAYS <br /> SIGNATURE OF APPLICANT DATF 'Ll�- <br /> Electranic Information: El List❑ Map--Description,, <br /> FILE ADDRESS END U$E ONLY , <br /> Street tF Street Marne City Unit 1 <br /> ae_ <br /> 2, SS" ice. . ;, <br /> U nit 2 <br /> 3. <br /> a• 2 Sbo <br /> Unit d <br /> 10.1 .`. ."; "..: <br /> :;4 <br /> Spe�lflc Dgte•IYan$I�.Pf Information Requested: From o r to _ rt33-A.t�- <br /> ._. ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 'A.11'a RGROUNb TAk1l (UST)CLEANUP SITE(LOP) ❑HOUSING ASATLMENT A SOLID WASTE FACILITYIVEHICL.E <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> UN:DERGRUUNO TANK(MONITORINUREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ®WAST€WATER TREATMENT PLANT <br /> 71FAFD PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRU0K/YA120ICWMICAL TOILET$ <br /> ❑UTTODIBODY PIERCING [ POOLISPA LAND USE APPLECATION SITES <br /> ❑ IVIEDICAI-WASTr FACILITY COMPLAINT REC OPUS FOTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECOlZDS ARE AwuL-AHLE FOR REVIEW: MONDAY-FRIDAY$:00 Am-5:00PM(EXCLUDING HOLIDAYS) <br /> 1, List un to ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> bpx(es). At least one file type MUST be selected. Fax to(205)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 rocelved after <br /> .3:00 pm will be,proaessed the next business day. <br /> 2. The EHD'will notify the applicant if any END files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after recelpt of application. The files will be hold for a maximum of five business days for review. Appointments. <br /> should be Scheduled accordingly. <br /> 3. Afile that is actively being worked on by EHD staff may not be Immediately avallable for review. Al now application r„ay be <br /> submitted wharf the fila is available. <br /> 4. Any'flIe•'n''ot rat rned In the same condition as released will be reorganized by EHD staff at the expanse of the applicant. <br /> Future file re'v16ws by the same applicant may require a$125 deposit prior to review. <br /> r,HD 11:L-()WLY <br /> I <br /> T4 39b'd NodldoAON�i S62T6696LZ 90 :�T ZTOZ/�,T/ZM <br />