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11//ZUU/{�ZU09 1b::728 San Joaquin County —> 4640138 2 <br /> U UI'--`��' �"/'I��D <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> 0 20G9 ENVIRONMENTAL HEALTH DEPARTMENT i-` <br /> TT 9)4 East Main St.Stockton,01 8 Web: <br /> L <br /> E��UlRCIiVfl'tNT HEALTtPlephone: (299)468-3420 Fax: (209)464.0138 Web:wwwsjgay.orgle ,,,/) <br /> I'CCR ik91TSER 10ES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; L/E88 b= RQL.aF BUSINESSIAGENCY: A.4�Fssn <br /> ADDRESS: g4 N . sa T 11..1 Sr s t ge) CITY/STATE/ZIP: 6r. .e ov 0,11 qs o,,. <br /> PHONE(1): (,2vg) 4(e L,..a70A PHONE(2): FACSIMILE:_Oor) q44-8575 <br /> TENTATIVE'APPOINTMENT DATE: Dec 4 avor{ Time: Iv:«p <br /> (Please allow 10 business days from dalo of appllca Ion 6ubmlRal•'Tenredva only-must be conOrmed) <br /> ❑CHECK BOX TO EXPEDITE REQVjESTT-$116 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT IV DATE IJo✓ j9 crony <br /> Electronic Information: ❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name APN city ❑Unit 1 <br /> 1' .270 COL IrP' eLLI - 10-06 SroEKroN 15.2,;- <br /> 2. <br /> am2. a13A AP) usA AD, 173-0 •,ir u � ❑Unit 2 \ <br /> 3. a44 -Tri. -nAN 1. 045.130- Lovl <br /> 4, 6. Hw Olq, <br /> 6' 35 N.CHs- og6r LN ., -O' LOD <br /> +01 <br /> 7. _. <br /> Il4 <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Units <br /> Specific Data Range of Information Requested: From1 j I12-L <br /> j gpon to ( (1 A p 1.Al F <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON•LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINOIREMOVAL) ❑DOG KENNEL El DAIRY <br /> ®HAZARDOUS WASTE GENERATOR [I CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> TATTOO/BODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW; MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List un 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. 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$115 deposit prior to review. <br /> 6. If you need further assistance,please contact Diane Martinez,at(209)468.3426. <br /> END Uaa ONLY <br /> EHD 49 Of 6127109 <br />