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' 13:35 FAX 559 256 1478 URS FRESNO <br /> ZU61 <br /> EHD LOG NUMBER <br /> D SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Jo17 <br /> 6(i)0 East Main Street, Stockton, CA 95202 3029 <br /> jplephone: (209)468-3420 Fax: (209)464-0138 Web: wwwsjgov,or <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> r, o4A1 sdN <br /> ,71-L•,1 O-g• L , j', �l /'A.l,t-(6�C BUSINESSIAGENCY: <br /> APPLICANT c r`t'r•- - t e Q37Zo <br /> IA1E� 1801 <br /> ADDRESS: �JO UC�z ;• 1 ssf--ir4- /478 <br /> r:N �,{(e- ILl6�S- PHONE(7):� L <br /> a -,230- 48T/° FACSIMILE: <br /> PHONE(1):�_ <br /> Time: <br /> TENTATIVE`APPOINTMENT DATE: <br /> (Please allow ten b0ness days from date of application submittal-'Tentative only.must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQtJES•$98.BQ FEE(CASH RCHECK ONLY)•REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> GV <br /> SIGNATURE OF APPLICANT .' DATE 491101d <br /> Electronic Information: [I List Map-Description: <br /> FILE EHD USE ONLY <br /> ADDRESS <br /> Unit 1 <br /> Street# Street Name <br /> Cay <br /> 1. /Dp 1I. 96010s- DR. (sC` x. T'. Stall toN ❑Unit 2 <br /> 2. aoo N. ea'jlzin. <br /> 3. 00 �. dda iL All.. S'ac.IL•(-oN q�nit3 \- \ <br /> 4. 00 �o\Ls'l t_ VL <br /> 5. "0 LWicTAt L SflL JN nit <br /> 6. 00 WL`G v :AUC. TnL4 tb}/ <br /> El Unit 5 <br /> e. w��c.lD ''J1U fZ S i«,kcoN <br /> 0. 3505 Nam iJr Il <br /> El Unit fi <br /> 10. <br /> to <br /> Specific Date Range of InformatiOrl:R uested:From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,,J/ ❑HOUSING ABATEMENT O SOLID WASTE FACILITYNEHICLE <br /> :tlJW'pERGROUND TANK(UST)CLEANUP S;i (LOP) 0 FOOD FACILITY 0 WASTETIRE <br /> HER CLEANUP SITE(NON-LOP) 0 DOG KENNEL 0 DAIRY <br /> DERGROUND TANK(MONITORING/REMOVAL) �CWCNEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> AZARDOUS WASTE GENERATOR ❑MOTELJHOTEL 171 PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> •TATTOOIBODY PIERCING j, 13 OTHER(PLEASE SPECIFY) <br /> ❑MEDICAL WASTE FACILITY y <br /> WELL AND SEPTIC PERMIT RaCORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 6:00 AM-S:OOPM 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 201111 464-011311 or mail to the above address. Address ranges will <br /> not be accepted-for addibonatessistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> be processed the next businesG day. <br /> exist. An appointment for review will be confirmed approximately ten <br /> 2. The EHO will notify the applica�4 if any EHD files <br /> held for a maximum of five business days for review. Appointments <br /> days after receipt of application: The files will be <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 /> 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> PUBLIC RECORDS RELEASE APP FORM <br /> EHD4e-06 101=07 <br /> I' <br />