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E RECEIVED ) 0 SANLHU LUU NUMULK <br /> ' ' -�'� .IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM111T V, <br /> rl <br /> V n L IJ 600 East Main St. Stockton, CA 95202-30 <br /> x <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: �( rg/eh <br /> 1 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: -e— 0 BUSINESSIAGENCY: 92.(oZ(o <br /> ADDRESS: S2an &uzcSlf ZOO CITY/STATE/ZIP: a0==rEZ <br /> PHONE (1): 5i0 (04-16 9 PHONE(2): �5i0FACSIMILE:510-295- 265 <br /> TENTATIVE*APPOINTMENT DATE: o 1 a Time: 'SAvv-,\ <br /> (Please allow 10 business days from date of applicatl submitta `Te tadve only-must be confirmed) <br /> CHECK BOX TO EXPEDIT QUE -$115 FQCA&SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESSSAYS <br /> SIG TURE OF APPLICA DATE (g ZSR/ <br /> Electronic Information: 91 List Map— cript n: Nkt enviroy-irvNek,4-60k on <br /> FILE ADDRESS EHD USE 0 Y <br /> Street# Street Name city .,? Unit 1 <br /> ,. 23 0 Y) ,AAve iIDD r <br /> 2. ' 1 T l coo lY d �` x 1$+ Y+ Unit 2 I <br /> 3. Z <br /> 4. (� O_ Ve I i' Unita I� <br /> 5. 3 S , Sfic /lie. , <br /> 6. 21 W . MAln S �_ ' r Unit4 <br /> 7 1_jj <br /> r� n. <br /> e.IQ•wy lam... a✓.^P�:.'..0 Y,_._ <br /> 8. 2 ( � I J ❑Units <br /> 9. <br /> 10. 12 n "..,2. ?C,9 Unit6 <br /> Specific Date Range of Information Requested: From PQ r "e tor-eSe r)-�' <br /> ENVIRONMENTAL ALTH DEPARTMENT FILES —7 <br /> I <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) E]HOUSING ABATEMENT SOLID WASTE FACILITY/VEHICLE <br /> THER CLEANUP SITE ry(NON•LOP) El FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCHASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑MOTEUHOTEL �UMPER TRUCKIYARDICHEMICAL TOILETS <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: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 /> 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 same applicant may require a$115 deposit prior to review. <br /> 5. If you need further assistance, please contact Diane Martinez,at(209)468-3425. <br /> EHD USE ONLY <br /> EHD 4e-0e <br /> 8127108 <br />