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From:DNC 2099825757 03/08121719 01:41 #708 P.001/001 <br /> v; <br /> L <br /> "bATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> "Uu'; <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> L 600 East Main Street, Stockton, CA 95202-3029 <br /> Z <br /> _.'p,�'..! _,ETe1ephone: (209)468-3420 Fax: (209)464-0138 Web:WWW.sjgov.org//d75 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: CBBUSIN1AGFVCY:'AVe' mgIL-2-7107Mi/e, <br /> ADDRESS: CItV1yj Stat,JZip <br /> PHONE(1) j0) PHONE —FACSIMIL <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-Must be confirmed) <br /> 13 CHECK 130X TO EXPEDITE ST-$ 05 10�( .OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU NESS 0�%YS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic information: 0 List 0 Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> 1. le"?� a �. [] Unit I <br /> S <br /> I �t" 05'� OR Cl <br /> —7 <br /> 17T <br /> 2. Unit 2 <br /> 4. 06 Unit 3 <br /> 5. <br /> 6. Unit4 <br /> 'Z��4�) <br /> 7. <br /> 8. 0 Unit 5 <br /> 9. <br /> 10. ❑ unit 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROU.-TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT C-3 SOLID WASTE FAciuTYNEMICLE <br /> 1E CLEANUP <br /> EA 'TE((N op) 13 FOOD FACILITY 13 WASTE TIRE <br /> 'OR"WREIOVAL) 13 DOG KENNEL 0 DAIRY <br /> UNDERGROUND <br /> L 'Up S (NON-LOP) <br /> MO <br /> TANK " <br /> C3 "OUSWASTE GENERATOR C3 CHICKEN RANCH M WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 13 MOTELIHOTEL 0 PUMPER TRucKfYARDICHEm TOILETS <br /> C3 TATroo/Booy PIERCING E3 POOL/SPA 13 LAND USE APPLICATION SITES <br /> E3 MEDICAL WASTE FACILITY C3 OTHER(PLEASE SPECI <br /> . WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 0:00 Am-5:00pm -EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the tYPO(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 mail 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 <br /> review. Anew 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 /> Emu 4a-06 =4/08 PUBLIC RECORDS—RELEASE App FORM <br />