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n LML)LUti NUM5_K <br /> TC—RECEI`!E° SAN JOAQUIN COUNTY - <br /> � � ,f <br /> a - `' 1 ENVIRONMENTAL HEALTH'DEPARTM�"f <br /> L Q;il 600 East Main St. Stockton, CA 95202-30 <br /> -Telerhone: (209) 468-3420 Fax (209) 464-0138 Web: � .7 rgleh <br /> PUBLIC RECORDS RELEASE APPLICATION jy <br /> APPLICANT: BUSINESSIAGENCY: F C-" 9 2{"z(v <br /> rT 1P: <br /> ADDRESS: �2 up_ , c Z O 0 . CiTYISTA E!Z / <br /> PHONE(1): 5 - (� FACSIMILE:5 f D—295-261 <br /> TENTATIVE`APPOINTMENT DATE: ( i c u z- - ZO 1 t7 Time: <br /> (please allow 10 business days from data of applicatlosuhmittal�`Terfffitfve only-must be confirm <br /> ) <br /> SACHECK BOX TO EXPEDIT (SUE $1'115 F NOR CHECK ONLY)-REQUEST PROCESSED W�BU$I ESS ,AYS <br /> TURE OF APPLICA [ l9 �r7✓ <br /> Electronic Information: List ap- trip# n: i rOV�me on <br /> FILE ADDRESS EHD USE o Y <br /> Street# Street Name City ...;''i_ Unit 1 <br /> 2. ► )(_K_ <br /> �:, <br /> � t�r1 �..� � �, 5,., Unit 2 <br /> 3. <br /> (��, v`•'4 <br /> 2021 <br /> 4. [� Q •L 1L. �!� I �J YY � 'r `r Unit 3 <br /> :. <br /> 6. Vv "�`Q i�li Unit 4 <br /> 7. h$• s.Lie- <br /> (03� O9.10. 1O 9 <br /> f Specific late Range of information Requested: From Y_ to <br /> ENVIRONMENTAL ALTH DEPARTMENT FILES —� <br /> NDERGROUNi)TANK(UST)CLEANUP SITE(LOP) ❑DOUSING ABATEMENT SOLID WASTE FACILITYIVEHICLE <br />!. OTHER CLEANUP SITE(NON LOP) El FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) [:]DOG KENNEL .. ❑DAWY <br /> WASTE GENERATOR ❑CHICKEN RANCH ASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ElMOTELIHOTEL MPER TRUCKIYARDICHEMICAL TOILETS <br /> �k&7ARDOUS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> 14 ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br />€ WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 13:00 AM-5:OOpm(EXCLUDING HOLIDAYS) <br /> 1. List up 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. 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 /> E 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 M the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br />'4 Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> 4 5. if you need further assistance, please contact Diane Martinez,at(209)468-3425. <br /> END USE ONLY <br /> EHD 48.45 8127109 <br />