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06 03: 29p fival.on Environmental 71483.66642 F. 1 <br /> RPSAWTEfiSAN JOAQUIN COUNTX EHD LOG NUMB <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Lfl�6 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> iAY l+ <br /> Telephone.(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd 3 �/ <br /> JIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PEU4(T rA <br /> APPLICANT: MC k Y okZ S- NK t OC R L BUSINESS/AGENCY: <br /> ADDRESS:- 1lt 1 N. Ti)_S'riv, Wait,_Sc.)-k 2-0., <br /> PHONE(1): —PHONE(2): (71`{)287-27GO FACSIMILE: (71 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQUEST- . FEE(C OR CHECFGJDtQL?).}REQUEST PR ESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT — G DATE .5-1 f `7 A)� <br /> UNIT DISTRIMBUTIOR ❑unit 1 ❑ Unit 2 0 Unit 3 ❑ Unit 4 Cl Unit 5 ❑ Unit 6 C3 Other(electrenicllists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> street 0 Street Name City <br /> 1. 223 rv� ---a � , 5;—%bc V_ t1k - _ - <br /> 2. <br /> 4. <br /> 3. <br /> 6. <br /> 6. <br /> J <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL-HEALT-H-DEPART-MENT FILES_ <br /> UNDERGROUND TAi1K(UST)CLEANUP SITE(LOA) O HOUSING ABATEMENT Q SOLID WASTE FACILrrYfVEMCLE <br /> ❑OTHER CLEANUP S€TE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDER(3P.OUIID TAIiK(MONITORINGIREIMOVAL) 0 DOG KENNEL ❑DAIRY <br /> ❑HAz:ARDOUs WASTE GENERATOR E3 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> ID TIERED PERmrrTEO FAciu Y ID MOTELIHOTEL C]PUMPER TRUCKIYARD/CHEMTOILETS <br /> In TATTOOIBODY PIERCING ❑POOL/SPA ❑LANDUsEAPPucATIONSiTES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFIC) <br /> WELL AnD SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00pM - EXCWDING 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 END 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 flies 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 /> eHD4aa2aaa <br /> 1M N05 <br />