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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL-HEALTH DlEPARTNIENT <br /> 600 East Main Street, Stockton, CA 95262-3023 <br /> Telephone! (209) 468-3420 Fax: (209)464-0138 Web: www.sjg h0 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: f? C+t R06z <br /> lN e LIhO RUSINES5IAGIENCY: �1� U!r o <br /> ADDRESS: jM d�(/ul�liTw ITVQ _ nn <br /> CitylStatelZip �} l�0- Ir,�f <br /> PHONE(1): 2,04- G -"4 b PHONE(Z): 204 x'21 <br /> ( ) 1`acSiMrLE: -�o? x(09 <br /> TENTATIVE*APPOINTMENT BATE: (Z- 4" a Time: R:30 <br /> (Pleas®auryw 10 busingss days from date a plication"BubrRittal-'Tentative onryust be confirmed} <br /> Q CHECK BOX TO EXPEDITE REQU $103 F C H O ECK ONLY)-REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OFAPPLICANT DATE Z- 1 � � <br /> Electronic Information: Cl List❑Map—beseription: , <br /> FILE AbDRJESS EHD USE ONLY <br /> Street# Street Name <br /> City <br /> 1. © Unit 1 <br /> e • r- D <br /> 2 t U `(11 SGC rS Ave?' <br /> © Unit2 <br /> 3. <br /> A'' fy� <br /> 5. <br /> ti. 1� c�S ✓ Gnit4.: . . <br /> 7. <br /> 3�( { <br /> o� FArAUn' <br /> it 5 <br /> 9- Ila L us s a� <br /> q:5Q 11nit6 <br /> 10 <br /> C) cljs4r�A l Ave- � <br /> Specific Date Range of Information 12equested:From to _ef-e_3.21Lk <br /> ENVIRONMENTAL HEALTH OI*PARTMENT FILES <br /> 14NDEROROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT ❑SOLID WASTE FACILrrY/VEHICLL <br /> W.OTHER CLEANUP SITE(NON-LOP) d FOOD FAciuTY o WASTE TIRE <br /> 74 UNDERGROUND YANK(MONrroRING1REMQVAL) ❑Do¢KENNEL 0]DAIRY <br /> 0I lAIARDOUS WASTE QEXERA7oR CI CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> I❑TIERED PERMITTED FACILITY ❑MOTEUHOTC4 ❑PUMPER TRUCKIYARDICAGM TOILETS <br /> C]'7_ATTOO1BpDY PIERCING b POOLISPA ❑LAND USEAPPUCAYtON SITES <br /> ❑MEWCAL WASTE FACILITY ❑OTHER(PLr:'ASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA$LE FOR RBYIEW- MONDAY-rR1DAY 8:00 AM.$,DOPM - EXCLUDING HOLIDAYS, <br /> 1. List up to ten addresses In the space above. ScIOCt the typa(S)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mall to the address Indicated above. Address <br /> ranges will not be accepted,for additional asslstance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day, <br /> 2. The END will notify the applicant if any EHD tiles exist. An appointment for review will be confirmed approximately tan(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should he 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 same applicant may require a$105 deposit prior to review. <br /> j EHD USE ONLY <br /> I <br /> f <br /> EHD 48-08 8104Iga PUBLIC RECORDS RELEASE APP FORM <br /> TO 39Vd NOdIM33ON3 96LT66560Z Ttt:TT BOOZ/LT/ZT <br />