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SAN JOAQUIN COUNTY F I L E COPTA HD LOG NUMBER <br /> 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> N 600 East Main St. Stockton CA 95202-3029 �Oqq <br /> None: (209)468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd <br /> �V1RON �IgER��C�s PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_j6jS4K �%'A BUSINESSIAGENCY: <br /> ADDRESS 3,j3q tniA.-ea,.:. 4* S7Ee. C CITY/STATE/ZIP: ell&' <br /> PHONE(1): PHONE(2): FACSIMILE: (Atb� 414-0160-5 <br /> TENT"IVC'APPOINTMENT DATE: Time- <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST- 122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ,�'�,e�..— k", DATE u 14 1?011 <br /> I Electronic information: ❑ List❑ Map—[description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Str6et Name I �1 city <br /> 1. '1� <br /> 2. �I%00 S t tr1�-A \ I Eq-4J'nIt 2 <br /> 3. gsc3 S <br /> 4. -ts <br /> 5. <br /> L-i L, g'\?tA _... .--.y 1 r —i!'(G'v-N���f�.. ('J'�N7C.%/V�M <br /> Unit 4 r <br /> El Unit 5 <br /> Specific Data Range of Information Requested: From "am to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �NDERGROUNO TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 3_s�ID WASTE FACILnYIVEHICLE <br /> HER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY STE TIRE <br /> FTIVU <br /> DERGROUND TANK(MONFTORINGMEMOVAL) ❑DOG KENNEL �RYARDOUS WASTE GENERATOR ❑CHICKEN RANCH STEWATER TREATMENT PLANT <br /> ED PERMrTTED FACILITY ❑,.._ WTELIHOTEL rulmm TRUCK/YARDICHEMICAL TOILETS <br /> IDTATTOO/BODY PIERCING LiMoLISPA ❑LAND USE APPLICATION SITES <br /> �I{EDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARI,AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uD to ten addressn 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(20 1464-0138 or mail to thej���1s Indleated abo)e. 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 fife 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$122 deposit prior to review. <br /> END USF ONLY <br /> END 4646 <br /> 01/28/10 <br /> 100/100 XVj 80:01 1102/bl/90 <br />