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- - vz r r�luiY nH.Lavu'i �Kt;t A 10002 i <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQM COQ 4 <br /> ENviRoNMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor, Stockton,CA 95202-270$ <br /> . Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.orgJehd1 <br /> 7.3 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPt3CANT: `��r� aC*Rei- 1 ; IBUSINEs51AGENCY:\PJeS�h <br /> ADDRESS. s $ fa�GlJr B%V�r :JV Fes_ �t 2, jtk\S\Uj-Clree C4b Iq <br /> PHONE(1): ��p LPS S PHONE(2): ;�5 $�2 _©b _�Acsna:Ire: 91 <br /> TENTATIVE`.APPOINTMENT DATE: MI `k r-n+•t_i n jA rt ua- [�fl{p 3im� :! <br /> s.: <br /> (Please allow 10 business days from bate f application submittal;7'entative only-must be confirmed) <br /> CHECK BOXTO EXPEDITE RE VEST-;93 ! E(CASH OR CHECK ONLY)-REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 1A 197-Je-5— <br /> uNn-DIST RIBUnON Lf Unit 1 C3 Unit 2 C7 Unit 3 0 Unit 4 0 Unit 5 Q Unit 6 0 Other(elactronlcflistslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street Z Street Name city <br /> CCC- n ;AW 2. H �s i- i=rc�o c� r��- �-0 1C c�3. k,v n - sc <br /> 4. <br /> 5. c " <br /> 6. 1 1 <br /> 7. <br /> B. <br /> 14, <br /> Specific Date Range of information Requested:From' to _-ff S�..'( <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES r . <br /> r� <br /> UNDERGROUND TANK(LIST)CLEANUP SfTE(LOP) 0 HOUSING ABATEMENT ©SCUD WASTE FAcmjTYIVEHH:LE <br /> 9THER CLEANUP.SfTE(NoN-LOP) 0 Fow FACilrrr 0 WASTE TIRE <br /> T�F/NDERGROUND TANK(MoNrraR1NG1REmovAL) ❑Doo KENNEL 0 DARY '. <br /> DOUS WASTE GENERAT P C3 CHlCKEN RANCH 0 WASTkwATER TRFATweff PLANT <br /> PEAmITTEDTACRITY Ci MOTELIHOTEL ©PumPmTRUCIUYARDICHEMTOI`:..ETS <br /> C7 TATToofSoDY PIERCING ❑PCOLISPA t 13 LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FAciLrrY MOTHER(PLEASE SPECiF1I} Sk� 'SS Mt 4 e' 1 StE+o-! TY- . <br /> WELL AND SEPTIC PERMfT RewpDs ARE AVAlLASLE FOR REVIEW- MONDAY-FRIDAY 8:00 ANS:ODpm - ExcLUDING HOuEwrs. <br /> 1. List up to tell addrmses in the space above. Select the type(s)offices 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 r � <br /> I <br /> indicated above. Address ranges will not be accepted—for additional assistance with fife addresses, contact <br /> the EHD.Applications received after 3:0 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHE)fries exist. An appointment for review will be confirmed <br /> approximately tern (i V)days after receipt of application. The files will be held for a maximums of f 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 /> Y1�i��_ I <br /> :I Vis'��.,�`•'� .i �..: <br /> , <br /> EHD 46-02-406 <br /> it <br /> II <br /> s <br />