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DATE RECEIVED r EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 96202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.orgle d 3 yp <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 5 Vi(d�l L SrA� 41f7 BUSINESSIAGEN�jCY: GC/ <br /> ADDRESS: �� P441( / <br /> PHONE(1): ✓,Jt/`f!p�i(/ aU/& PHONE(Z): fl/,' <br /> �(pVl � W FACSIMILE: Jc�V�fO <br /> TENTATIVE*APPOINTMENT DATE:, /U At Ott 2zol Time: 5.'0 e) <br /> (Please allow ten business dayt m date of applications mittal-'Ten five only-must Pp confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQU ST,-$9ti. 0 F E(CASH OR CHECK ONLY)-REQUEST ROC SSED INT EE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 5#9 DATE S-1S-aS <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Streot# Street Name city ❑Unit 1 <br /> WE + w J` e - �✓ Ali? , P <br /> do � 2 �b8 Lfk W J!5�f, 1401 ❑Unite <br /> 3. f ✓ L'IH 51, Skk 6 <br /> S. �% <br /> 6. /� t' 11n� � UM it <br /> 7. O <br /> 8. ©Unit 5 <br /> S. <br /> 10. <br /> ❑Unit B <br /> Specific Date Range of Information Requested:From a4n4dµ1 � _ to N Roos <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> *UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑SOLID WASTE FAc[LITYNEHICLE <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> WNDERGROUNDTANK(MQNITORING/REMOVAL) 0 DOG KENNEL ❑DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR M CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY Cl OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILAOLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM - 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 appropriate <br /> box(es)- At least one file type MUST be selected. Fax to(209)464-0138 or mail to the above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> 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 <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 the END staff may not be immediately available for review. A new application <br /> may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHb staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 18129107 PUBLIC RECORDS RELEASE APP FORM <br /> Z0/Z0 39Vd dI-ido ON snivel lis 90099L90E5 9Z:60 800Z/9Z/90 <br />