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yepZ V V d IQ: I IAM No, 2539 F. 1/2 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT00% ww, <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: /0 <br /> r www.sjgov.ohl <br /> JOV <br /> or <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> AP PLICANT. _kOLPI-ah —BUSINESSIAGENCY' /0A <br /> l <br /> ADDRESS; VO jZ 54A, MAO City/StateIZIP ... ww�Andt cra;, oa, <br /> PHONE(1); X6 PHONE(2): FACSIMILE: flzA 1.39 Act <br /> TENTATIVE*APPOINTMENT DATE:. —Time, 14 1'+7 <br /> (Please allow 10 business days from dad,of application submittal-'Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$1q6 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE � v <br /> Electronic.Information: $1 List El Map—Description:, Z2 /10 15 L!6_ 61-77 1 <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city — ,k ® Unit I <br /> 37,0 mcloy Ave, 6�VC461*kl mo d 19. Ald wx��-/u F r, <br /> 2. ?_1 7 El UnIt2 <br /> 4. 665 A A <br /> .......... <br /> lu-40A5. 40 <br /> 6. Unit4 <br /> 7. <br /> 8- <br /> 0 unit 5 <br /> - <br /> 9. 0 uy ................ 11L <br /> ❑ Unit 6 <br /> L-0 <br /> Specific OnforlUrrReT a"�Pmri,\77 0011 155409 - <br /> qu <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> F <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT 0 SOLID WASTE FACIUTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) C FOOD FACILITY C3 WASTE TIRE 1f1qlflq <br /> NDERGROLIND TANK(MONITORING/ EMOVAL)(X 11 DOG KENNEL 0 DAIRY <br /> UNDERGROUND <br /> WASTE GENERATOR 13 CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 13 MOTELIHOTEL 13 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 13 TATTOoIBODY PIERCING 13,PQQLI$PA <br /> 0 MEDICAL WASTE FACILITY -XOTHER(PLEASE SPECIFY) V J'se, <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8.00 Am-6:00pm - EXCLUDING HOLIDAYS. <br /> 1. List up to ton addresses in the space above. Select the type($)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 aggrgegi indicated ah2ye,, 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 ton(10) <br /> days after receipt Of application. The files will be hold 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> 4p- A_17,n� - <br /> IV dkdZ <br /> i9,11AJ kZQdhi-(4dy fil E 6' "�,7o 6j,if ,e - let,- <br /> e- <br /> nrl' liub <br /> -ii-HO 48-06 PUBLIC RECORDS RELEASE APP FORM <br />