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j� r�^� � � <br /> W r_ � E I SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> UG 1 2 7 [000j 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.SJgov.ogd <br /> ENL Pr i i <br /> PEEI01F1ICM; PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTLC� T�.„; BUSINESSIAGENCY: r >` QTylee's <br /> ADDRESS: Ave. CITYISTATEMP: Slcrawc to U 95al _ <br /> PHONE(1): q16 tf�O 0, g PHONE(2): FACSIMILE: 1(6 45/? LA03 <br /> TENTATIVE*APPOINTMENT DATE: ASAP Tine: awn <br /> (Please Slim 10 business days from date of application submltial-"Tsntattve only-must be confirmodY <br /> ❑ CHECK BOX TO EXPEDITE RE EST-$)I5 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSEO IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE/iJ a7.Oa <br /> Electronic Information: ❑List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> streets Street Name city Unit <br /> i. Spr Ae_ s< A _ <br /> 2. e(5 ° nh 2 <br /> 3. \ <br /> 4. nh3 <br /> 5. <br /> L7. <br /> nit 4 <br /> ❑Unit 5 <br /> nh e <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �{ <br /> UNDERGROUNDTANK(UST)CLEANUP SITE(LOP) [I HOUSING ABATEMENT SOLID WASTE FACILRYNEHICLE <br /> OTHER CLEANUP SITE(NON•LOP) El FOOD FACILITY WASTETIRE <br /> NOERGROUND TANK(MDNRORINGIREMOVAL) El DOG KENNEL DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL LIMPER TRUCKNAROICHEWCAL TOILETS <br /> ❑TATTODIBODY PIERCING ❑POOLISPA NO USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW: MONDAY•FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> i. List u0 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. (2091464-0138 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 appilcant h any EHD Ries 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 flls reviews by the same applicant may require a$116 deposit prior to review. <br /> S. H you need further assistance,please contact Diane Martinez,at(209)458-3425. <br /> fixe use GWY <br /> EHD 4946 827M <br /> 100/100Q� HVj 1Z GO 6002/LZ/OL <br />