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RCVCI V CL.J <br /> JUN 0 7 2011 bmlt6yEma11 Print Form <br /> 0 <br /> DAT["RECEIVED SAN .JOAQUIN COUNTY <br /> COnYvette ENTAL <br /> HEALTHSNVIRONMENTAL HEALTH DEPARTMENT � <br /> YvFtte PERMIT/SERVICES <br /> direct phone 600 East Main St, Stockton, CA 95202-3029 yty <br /> 209-468-3421 Telephone: (209)468-3420 Fax: (209)4640138 Web: www.sjgov,org/ehd <br /> or Cheryl Field PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �Z C�'(I S,U BUSINESSIAGENCY: A ES CID.-7s,L wlif <br /> ADDRESS: 2S`00 ( Gw c \O `[)i�cto(d CITY/STATEITIP: 'K*(vw� C✓�e t� /L���$�� <br /> PHONE (1): (Q2f) -I-`t�.-VCWl PHONE(2): 600b FACSIMILE: (R2,r) 4'1-[G- (j2 Qq <br /> TENTATIVE"APPOINTMENT D TE: Time: <br /> (Please allow 10 business d from date of application submittal-'TeafafNe only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQIy S - 15 F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 6 2,6 t I <br /> Electronic Information: 0 Lls Map-Description: tµ2 2?_-eel A r t1u Q se_ i Cc- <br /> FILE <br /> c -FILE ADDRESS END USE ONLY <br /> Street Street Name City 0 Unit'I <br /> 1 Cv DOLc (eS Ave., a r,{`e �o <br /> 2. G S(}CIez Unit2 (� <br /> 3. <br /> 4. feclip< 1J'�. ,p Unit3 <br /> Unit a <br /> 7. <br /> 8. Cl Unit$ <br /> 9. <br /> 10. Unit 6 <br /> Specific Date lunge of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 971UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT ASOLIO WASTE FAMITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY �+{WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOvAL) EjDOG KENNEL LXJDAIRY <br /> ']HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEt PUMPER TRUCKNARDICHEMICAL TOILET5 <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA 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 tiles from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0136 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 EMD 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 name applicant may require a$115 deposit prior to review. <br /> 5. If you need further assistance,please contuct Diane Martinez,at(209)468.3425. <br /> END Ube ONLY <br /> 1 . —S E <br /> No <br /> EHD 41 s1247oa <br /> 10/10 39vd S1Nvilr1SN09 I3V 66099bL9L6 89:0T TTOL/L0/90 <br />