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Uel 1,)/ /-rju D 11.�)b 171 b 3(fit (tJ7 bLPUKbUKN UUNSUL 1 1NU F'AUt bl <br /> EHD t.OG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> F 13 13 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/eh <br /> ENVIRONMENT. ,1EALTK <br /> PEBMiT12RVI,OFe PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: _Z0/11& BUSINESSIAGENCY: LAG 91ze_A1 1_4&AAt7-IN6 <br /> ADDRESS: 2_�/-3-� . _ K'��1l T,�7�i41 E7— CltylStat9/Zip �sy- S�4�,�m �uTn CA 9s691 <br /> PHONE(1): .TS - 5� U PHONE(2): 9 141 22Z lV 2 FACSIMILE: 91(.- 3_76'- Z 70 <br /> TENTATIVE"APPOINTMENT DAT _V? <br /> 5' 7�7 7 �w 31.2 _Time: /6 G.n _ <br /> (Please allow 10 business days from date o1 app Icativn submittal-'TBntadV6 only-must be confirmed) <br /> I7-3 CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTDATE <br /> Electronic Information: ❑ List❑ Map•-Description: <br /> FILE ADDRESS _ EHD USE ONLY <br /> Street 0 Street Name City ❑ Unit 1 <br /> zoo <br /> Z.... n� Unit2 <br /> / / o U. �'�'Qrtrl14 G_F_ <br /> nit 3 <br /> 4. <br /> -......... <br /> -- ---- <br /> 5' nit 4 <br /> 6- <br /> 7. <br /> _. ._. .. .. ....... __.--.._..__. _._ _ ❑ units <br /> 6. <br /> -9. ❑ Unit 6 <br /> -- <br /> 10. <br /> Specific Date Range of information Requested:From to 29 E'S1__ATT <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) CI HOUSING ABATEMENT d SOLID WASTE FACILITYIVEHrCLE <br /> R OTHER CLEANUP SITE(NON-LOP) ©FOOD FACILITY o WASTE TIRE <br /> 0 UNDERGROUND TANK(MONITORINo(REMOVAL) C3 DOG KENNEL. 0 DAIRY <br /> 0 HAZARDOUS WASTE GENLRATOR ❑CHICKEN RANCH C3 WASTEWATER TREA-rMENtPLANT <br /> 0 TIERED PERMITTED FA(71t,ITY C)MOTELIHOTEL M PUMPER TRUCKIYARD/CHEM TOILETS <br /> CI TATTOOfBDDY PIERCING ❑POOLJSPA ■LAND USE APPLICATION SrTEs <br /> 11 MEI)MAL WASTr•FACII.JTY ©OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-S:DOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the type(s)of flies from the fist 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 same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EH17 4806-0104108--- <br /> _ PUDLIC RECORDS RELEASE APP FORM <br />