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vVrcrrcvuv Avr IV. W4 r'4A �- <br /> i�aa��aal I <br /> GATE RECEIVED EHo LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax; (209.)464-0138 Web:www.sjg0V.org! <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> n <br /> APPLICANT: Kl/l I e L aL K-�ia r+— _ BUSINr=SSlAGENCY: _ 1C - JT SSCJ c r fC <br /> ADDRESS: - 161(4 [ Ga M Q Dr l'v # a b � �., `�S�' 7 C: <br /> PHONE(1):�q/6 -&n;-3&n;-3--r,2 9 3 PHONE(2): FACSIMILE: <br /> I `l TENTATIVE' APFOINTMENTDATE: 15f 0 rme: <br /> (Please allow ton business days from date of application submittal•'Tentatlye only-mUstbe Bort mad) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$98. CASH OR CHE Y)•REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _. IC - - - DATE __- <br /> Electronic,lnformation: fiffList El Map-Description:;_ C--D! _2 a tit i u5 Jl 4 io <br /> FILE ADDRESS _ EMD USE ONLY <br /> Street# Street Name City ❑Unit t <br /> 1, (Q l j W• rah- Iti Cdctd:. <br /> 2. t Ir _rrac Gt3 $ ;�ayl� []Unit2 <br /> 3. 3 Cs l I - s I TrGc c filo c� <br /> 4a Tr, { 5�� Mita <br /> S. w .��a Road Trac a <br /> ocD <br /> 6. 05573 �,��t1 2r� Trot[ 5a� _4d5CA7 nit4 <br /> �LCj ra Int L 1 2c •_vac �`�S3 -k -3o3 <br /> s. 360 r0.4{+ l i'A�L. R,)rLd Tr4r '75,5- c36Z,- 9ZO1505 ❑Unit <br /> 9. { �S$U - W...6raKi- L,xe, (Zoa Trac cfS.3Ct ' d <br /> 10. nit 6 <br /> Specific Date Range of information Requested:From to <br /> ,{ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ) UNDERGROUND TANK(UST)CLEANUP SITE(LAP) ❑HOUSING ADATEMENT )1�$01_10 WASTE FACILITYlVEHICLE <br /> OTHER CLEANUP SITE{NON-LOP) ❑FOOD FACILITY 9WASTE TIRE <br /> 4 UimERGROUND TANK(MONITORINGIREMOVAL) 17 DOG KENNEL. ❑DAIRY <br />' Xr HAZARDOUS WASTE GENERATOR d CHICKEN RANCH ❑WASTEWATER TRE'ATMEW PLANT i <br /> i 0 TIERED PERMITTED FACILITY ❑MOTWHOTEL 13 PUMPER TRUCN/YARDICHEM TOILETS <br /> ❑TATTo0B0oY PIERCING ❑POOLISPA 0 LAND USE APPLICATION Sam <br /> r 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) ' <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW=MONDAY-FRIDAY 8:00 AMS:OpPM-EXCLUDING HOLIDAY$, <br /> 1. last 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.•l=ax to(209)464-0136 or mail to the above address. Address ranges wil I <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 bus inoss day. <br /> 2. The E14D 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 EHD staff may not be-immediately available for review. A new application <br /> may be submitted when the file is available. <br /> I 4, Any file not returned In the same condition as released will be r9organlzed by EHD staff at 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 /> s <br /> EHD 48-06 10129H17 PUBLIC RECORDS RELEASE APA FORM <br /> r � <br />( <br />