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E0,d lfu101 0 0 <br /> DATE RECEIV`E�DSAN JOAQUIN E:FiD LOG NUMBER <br /> I C <br /> �' J ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> A k 2 12009elephone: (209)468-3420 Fax: (209)464-013$Web:www.sjgov.org d <br /> ENVI-R N MENT.HEALTH PUBLIC RECORDS RELEASE APPLICATION66.. 11/� <br /> APPLICANT: i Qr an n BUSINESS/AGEENNCY: �VCV5' / <br /> ADDRESS. ��i (*!f 1W_ Ar, e— A q City/$tatelZip (Z� o. C.. <br /> PHONE(1): ! �O`1 :'�091 _ PHONE(2):A, r^3 ZICA ��"Z �( FACSIMILE: <br /> /i <br /> TENTATIVE*APPOINTMENT DATE: ms t - Time: 'E'34 <br /> (Please allow 10 business days from data of application submittal-*Tentative only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATEG/ Z1— pI <br /> Electronic Information: [I List I]Map--Description: <br /> _._._.._.._..,._.._._ _ FILE ADDRESS EHD USE ONLY <br /> Streett Stre�tNama City —...w- ,......__- <br /> cZg4 `, p Unit <br /> 2. Q 'a�r,....,811� - Cp2� 0C 51�o c�( e-❑ n <br /> 3 �a 1n <br /> 4 oto_--- - Ma; j� , <br /> 5. <br /> CA- <br /> 6. I q � '. I{ 5 HP/l arc¢ 10E <br /> 88 ❑ Unit 6 <br /> . <br /> ------_.._._._.�._.._........... ------- ❑ Unit <br /> 10. <br /> Specific Date Range of Information Requested: From e01-11cir to AIC, } e*e_61A <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> eli NDERGROUND TANK(UST)CLEANUP SITE(LAP) 0 HDu51NG ABATEMENT CJ SOLID WASTE FacluTY/VErtICLE <br /> 1 <br /> jTHER CLEANUP.SITE(NON-LOP) O FOOD FACILITY ❑WASTE TIRE <br /> 4NDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL ❑DAIRY ��1 <br /> $nAZARDOUS WASTE GENERATOR E3 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEUHOTEL ©PUMPERTRUCK/YARD/CHEM TOILETS <br /> M TATTOO/BODY PIERCING 0 POOUSPA d LAND USE,APPLICATION SITES <br /> 11 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAIL ABLE FOR REVIEW- MONDAY-FRIOAY 8:00 AM-6:00PM - 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> -IaqD 0N. <br /> � J-o <br /> 0 ;� <br /> d iO3 1 40 <br /> EHD 4$-06 8l041oa PUBLIC RECORDS RELEASE APP FORM <br /> EolEo'd 6620 998 SF6 T G311JN0dH00NI 030N3 22:9I GOOF—TE—ddd <br />