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DATE RECEIVED EHD LOG NUMBER <br /> I�F 1�' UIN COUNTY <br /> —Ln <br /> JEW HEALTH DEPARTMEN ' <br /> t Main StreetStockton, CA 95202-3029 C <br /> FB (2O0� Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov,0 e J <br /> E�!'v;!vi V'N i<<iT HEt,LT" PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT IR100 La Llug BUSINESS/AGENCY: Lf,fa Gfoxir.N�Er Sn <br /> ADDRESS: 7'/r.I (tioemv r Fain—_UqAr'r.— <br /> PHONE III: !;F&- PGS^ R!0 PHONE(2): 4YL 8 ) 9 7947 FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time <br /> (Please allow 10 buolneae days from data of application submittal.OTen�dae onlymoat 6a connnn <br /> 0 CHECK BOX TO EXPEDITE REQUE$T 00 FEE(CAS�H/OOR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS <br /> SIGNATURE OF APPLICANT . ✓✓1 ��` DATE .2- a., o* <br /> Electronic Information: © List El Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Streets Street Name City ❑]Unit <br /> 1 41yt Ec . ur zv�k � <br /> 2, E7 7 ❑ <br /> 4. <br /> 5. — <br /> Un <br /> 6. <br /> 7. <br /> ❑ Units, ' <br /> 8. <br /> g. <br /> [] Unit 8 <br /> 10. <br /> Specific Date Range of Information Requested: From 7AW to <br /> ENVIRONMENTAL HEALTH DEPAR ENT FILES <br /> ID UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILnxNEHICLE <br /> Q OTHER CLEANUP SITE(NON-LOP) Cl FOOD FACILITY ❑WASTE TIRE <br /> 0 UNDERGROUND TANK(MONITORINOIREMOVAL) 0 DOG KENNEL ❑DAIRY <br /> O HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCK M WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL Q PUMPER THUCK/YARDICHEM TOILETS <br /> TATTOO/BODY PIERCING 0 POOLISPA M LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑OTHER(PLEASE SP � <br /> ECIFY) ,��� 2,dz/C4 .T/O L(T)'.fl <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-B:OOPM - ExcwontG 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 mall 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 file reviews by the some applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EN �e:�v4Ea"l(>rf7�'M7 _' <br />