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� f^`V V <br /> j=�E EHD LOG NUMBER <br /> °1 1;Hk,� - � SA.N JOAQUIN COUNTY <br /> E',VYRONMENTAL HEALTH DEPARTMENT <br /> L006 304 East Weber Avenue,3`6 Floor, Stockton, CA 952.02-2708' lephone;(209)468-3420 Rax:(209)464-0138 Web:www.sjgov.*rg/ehd300(o <br /> LNV1R.T111,`+r N i 1 iLE r <br /> PERM;ii' CER',110E5 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 2a�yr o a61 Q r BUSINESS/AGENCY: 0_0v\5 1-4-t '✓tA <br /> ADDRESS: -_�%� 7'7 S Elk",0 ��'. �SDO NAS .�1> �� �OIIU <br /> PHOhtE(1):_ <br /> •71A Q _9 "d_50' 3 PHONE(2): FACSIMILE: 303 '7�S"��� <br /> TENTATIVE"APPOINTIWENT DATE. "TL %A r s da.-i4 . &2f'. 13 Time:_ <br /> (Please allow 10 business days from date of appllcatibnnsubmittal-'Tentative only-muq be confinned) <br /> BY CHECK BOX TO EXPEDITE RsquEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ( � —DATE 4-1-7 )C)Ca <br /> UNIT DISTRIBUTION El Unit 1 0 Unit 2 M Unit 3 Q Unit 4 0 Unit 3 M Unit 6 M Other(electroniclli5tslmaps) <br /> FILE ADDRESS APOR EHD USE ONLY <br /> Street IY T� Street Name City <br /> F2. k'. - 9 <br /> 5. <br /> 7. ,. ..._ <br /> 8. i <br /> 10. <br /> Specific Date Range of Information Requested:From <br /> ENV'I 6k_mENYAL HEALTH DEPARTMENT FILES <br /> OUNDERGROUND TANK(UST)CaANuP SITE(LOP) 0 HOUSING ABATEMENT ❑SOLID WAS rE FAc4uyYNEHICLE <br /> 19 OTHER CLEANUP SITE(NON-LOP) <br /> C3 FOOD rACILITY 0 WASTE TIRE <br /> MrUNDERGROUND TANK(MONITowNoIRFmOvAL) 13 DOG KENNEL ❑DAIRY <br /> ErNAIAROOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WAsTEwATERTREATmENT PLANT <br /> TIERED PERMITTED FACILITY ❑MoyrLJHOYEL 0 PAMPER TRUCK/YARDICHEAC TOILETS <br /> ❑TATTOOiBoDY PIERCING d POOLISPA d LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPEOIFY) <br /> W ELL AND SEPTIC Flmwrr RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM5:OOPM - 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 <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 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 <br /> approximately ten(10)days after receipt of application. The files 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 48-02.004 <br /> Iti41a6 <br /> E0/Z0 39dd 0NIrinSN00 63 9ZL688LE0E LI:ET 90OZ/L0/b0 <br />