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o e 1), z. z Uv o Iv I i Am No. 2539 P. 1/2 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q, 600 East Main Street, Stockton, CA 95202-3029 <br /> J8 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.or 13/e/eh <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:. BUSINESS/AGENCY: P10 eolrllv /O--1 <br /> ADDRESS; AK 5kf�,' 11A0 Clty/State/Zip wz/np(� <br /> PHONE 11): J�15)138_&O XLO, PHONE(2)- FACSIMILE! -1,�A2 <br /> TENTATIVE*APPOINTMENT DATE: —Time: 14"1 <br /> (Please allow 10 business days from datd,of application submittal-"Tentative only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 313USINESS DAYS <br /> SIGNATURE OF APPLICANT DATE L40 Z, <br /> Electronic information: List El Map-Description: bf!57 e,,166, /P,$jj 6,4t!�5 <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city Unit I <br /> 1. z3 2-0 y Ave, <br /> 2. 217 ❑ unit 2 <br /> 3. <br /> 4. <br /> 665 <br /> 6. UnIt4 <br /> 7. /1 s \ <br /> 8- <br /> -) <br /> L1 unit 5 <br /> - <br /> 9. Uy <br /> L1 Unit 6 <br /> 10. <br /> L 4r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �7 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E3 HOUSING ABATEMENT 0 SOLID WASTE FACILITY/VEHICLE K <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY E3 WASTE TIRE <br /> (?'� 171 <br /> NDERGROVND TANK(MONITORINGIREMOVAL) DOG KENNEL M DAIRY <br /> UNDERGROUND <br /> WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 11 TIERED PERMITTED FACILITY 13 MOTELIHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 13 TATTooffioDy PIERCING CI OLI$PA 0.4AND USE APPLICATION SITES <br /> E3 MEDICAL WASTE FACILITY /WIHER(PLEASE SPECIFY) A&� 146e- <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8(00 Am-5:00pm - EXCLUDING HOLIDAYS. <br /> 1. List up to ton addresses in the space above. Select the type(e)of files from the Ifst above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)4114-0138 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 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 /> Futurefile reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> A- <br /> ig/15j i?zij A dhIe-bf '�-7,0�; Q4 C-1J&,td -AW <br /> WAKf5 CLwy <br /> EHD 46-06 8/0 0 PUBLIC RE ORDS RELEAS­ <br />