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0 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN .lOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT (///�� <br /> (i00 East Main Street, Stockton, 38 95202- WW. /100 <br /> V 1/ <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjg h <br /> PUBLIC RECORDS R_iELEASE APPL�ICATI <br /> APPLICANT: G N LfO BUSINESS/AGENCY: ONnV <br /> CU <br /> ADDRES: W"1111 AV, CltylStatetzip la <br /> G <br /> PHONE(1): <br /> PHONE(2): 2UQ 1( Z b b S, IEACTSIMILE: ---22J.-d <br /> TENTATIVE*APPOINTMENTOATE: (Z"3a-0Time: R:30 <br /> (Please <br /> (Please allow 10 buslnBss days from data a plication submittal-•Tentat/ve only-must be confirmed) <br /> CHECK BOX TO ExBEOITE REQU $105 F C H O ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS GAYS <br /> SIGNATURE OF APPLICANT DATE l2 ', l-�L-Ob <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street A Street Name City <br /> // unit 1 <br /> 1. � '/tU vh f. SIP," . o ❑ <br /> 2. ` U k Don n Sy. '4Pe? ❑ Unit <br /> 3. e G 2 =°,�. <br /> 4. 2 D 5. s-�nCLttU., f; ,S=7 5' c-O Unit s <br /> s. I S <br /> 6. 314 6 078 ✓ unit4 1J <br /> 1 <br /> 7. 3� l I s 35a <br /> g. 33'} 14 ❑ unit 5 <br /> a R <br /> s. L s /s , n aP ❑ Unit fi <br /> 10. Z3 p ± &13TrPw j AVG <br /> Specific Date Range of Information Requested:From Qaf b$1 to fJrt'S�b>Z <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 4NOEROROUND TANK(LIST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> 'UN CLEANUP SITE(NON-LOP) MFOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) M Dog KENNEL ❑DAIRY <br /> 'HAZARDOU5 WASTE GENERATOR C3 CHICKEN RANCH O WASTEWATER TREATMENTPLANT <br /> ❑TIERED PERMITTED FACILITY El MOTEDHOTEL 13 PUMPER TRUCKIYARD/CHEM TOILETS <br /> In TATTOOIBOoY PIERCING ❑POOUSPA ❑ LAND USE APPLICAYION SITES <br /> ❑MEDICAL WASTE FACILITY ©OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW .MONDAY-FRIDAY 8:00 Aw5;00PM - 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 file type MUST be selected. Fax to 209 4840138 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 now 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 same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-08 9/04 OOD PUBLIC RECORDS RELEASE APP FORM <br /> TO i tr -, ­ ---1 1. � ­ <br />