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OATS RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3'd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sigov.org/elid ZP70 <br /> _ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: IItY BUSINESS/AGENCY: fTt(' {in�jlT <br /> ADDRESS: ,✓ 95 Mort Ile, �t4YLi(Y F P/1adrtnt ffil( , t[lzl I -(/a ��f5�� � <br /> PHONE(1): 10 X PHONE(2): 9�5��Sd -5�3L �eell J FACSIMILE: �".75 -//O, -2' e <br /> TENTATIVE'APPOINTMENT DATE: Time: /0'M( <br /> (Please allow 10 business days from ata of apipffication submittal-`rentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �L./!��. Lt, t C �j_r DATE Ole 6 <br /> e' <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name 1� City ❑ Unit 1 <br /> 1 <br /> SOS � �l1[irtliY W 1 C <br /> 2. 5 I S V1� r�4t' wG� r1v- dY� C] Unit 2 <br /> 3. 4 LI 0 W C rt& JI jcbxt <br /> Unit 3 <br /> 4. 41-/ / NI C arw <br /> 5. 414/ W k Vl/AG �fvC�t�L� <br /> Unit a <br /> 6. 14& 5 s 'Unwil Y& d&X-1/ Ole <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,d UNDERGROUND TANK(UST)CLEANUP SITE(LOP) d HOUSING ABATEMENT c 3-tS LID WASTE FACIUTY/VEHICLE <br /> OTHER CLEANUP SITE(NOWLOP) ❑FOOD FACILITY Cl WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEL/HoTIuL ❑PUMPER TRUCHNARG/CHEN TOILETS <br /> ❑TATTOWBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> M MEDICAL WASTE FACILITY D OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PEP Arr REcoRDs ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 9:DO AM-5:OOPM - E=XCLUDING 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)454-9139 gr 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 Ale reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EH0411-0e 9/13120$ <br /> TO 39dd Hd DNINi ]3NIDN3 DI13 OZtbZ095ZGT Z0:60 9002/ZT/ZT <br />