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530s76sIe0 '� <br /> I <br /> STRATUS.ND PAGE 01.101 <br /> EHD LOG NUMBr-R <br /> aSAN J0AQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2008 600 fast Main Street, Stockton, CA 95202-3029 <br /> : <br /> Telephone: (209)468-3420 Fax: (209)4640138 Web:www.sj30vor <br /> NtI�C1N,���,EN F <br /> E ,l_T <br /> ' �'"� � ' ��f ° PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT_ S�1Y S �f`irati, vti4+� T"Ac• aUSINESSIAGENCY: cz, .1n ct�C'*�CQo <br /> ADDRESS: `3'3 3o Co_'rnt C5'n ?ark (1- Citylstaterzip C . A <br /> PHONE(1): 530) �31S CG1" fR-0 PHONE(2): C-1"K) 3�0- `c}Df�'� (r-00 FACSiMiLE: 534 ioito� [�L� <br /> TENTATIVE`APPOINTMENT DATE: l o � Time: a_ K" <br /> (Please allow 1 D business days from date of application submittal-*Tentative only.must ba confirmed) <br /> Q CHECK BOX To EXPEDITE RSr-$105 FEE{94SH OR CHECK ONI-Y)-REQUEST PROc5tSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF,APPLICANT: DATE* to'1_7( cD� <br /> Electronic information: ' '❑ List❑ Map—Description: <br /> r FILE ADDRESS EHD USE ONLY �. <br /> : Street# ` '` Street Name city ❑ Unit 1 <br /> UY r HQXYI Mer <br /> �c�rlQ � cr � �7 m CvtrCs� <br /> 2. 202 (l,a- i +r►�� ,nc. t 8p� ciG4 an (P ❑ Unit 2 <br /> l <br /> I <br /> 3. <br /> 4. <br /> nit ! <br /> ! <br /> �. t!nit�4 <br /> Z1 <br /> 7. <br /> 8. <br /> 9. ©. Unit 6 <br /> Specific Date Range of Information Requested:From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Hovs1NG A"YEMENT 11 SOLID WASTE FACILITYIVEHICLE <br /> UNDERCROUNO YANK(UST)CLEANUP SITE(LOP) TY ❑WASTE TIRE <br /> 0 OTHER CLEANUP SITE(Noo-LOP) 0 Faoo FAC1Lt0 AST <br /> ❑UNDERGROUND TANK(MOMTOFRINGIRFMOVAL) d DOG KvNN£L <br /> mAy <br /> SWAT <br /> OU5 WASTE GENERATOR 0 CFOCKEN RANCH C I WASTEWATER TREATMENT PLANT <br /> C3 tiA7�1RDFACILITY ❑MOTEtJHOTFL b PUMPER TRucKl1 ARDICHEM TOIL <br /> TIERED ETS <br /> OUS PERMITTED <br /> C3 TATTOOfBODY PIERCING 1�POOIJSPA LAND USE APPLICATION SITES <br /> in MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMrr RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FrUDAY 8:00 Am-6,00PIA - EXCLUDING HOLIDAYS- <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one fie type MUST be selected. Fax to 209 464-0138 or maij to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with fie 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 canfirrevi approximately ten{10) <br /> days after recetpt of application. The files will be held fora 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 immedia#ely available for review. A new application tray tae <br /> submitted when the file-is available. <br /> 4. Any file not returnod in the same condition as released will be roorganized by EHD staff at the expense of the applicant. <br /> Future file roviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> I <br /> PUBLIC RECORoS RELEASE APP FORM <br /> EHD 4MG $104108 <br />