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DATE R <br /> TC EHD LOG NUMBERP <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> TltVihono: (209) 468-3420 Far (209)464-0138 Web: www.sjgo)i.org/ehd <br /> 0 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Kvi�&n BUSINESSIAGENCY: <br /> ADDRESS: 38 4X SmAt C CITY/STATEIZIP-. <br /> PHONE(1): ft. Lt®-02.34> PHONE(2): (S; <br /> g, n%--pt-Ab FAC$IMILE:_(qt6 gov -R(.Ps <br /> TEN'rA*r1VE*APPOINTMENT DATE: Time: <br /> (Please allow 10 buriinerss dayr,from sato of application submittal-*Tantafiva only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REOUFS5.$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Aga& _- � � DATE q1431,0 <br /> Electronic Information: [D ListE] Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Nome city 0 unit I <br /> qI10 wo-q <br /> 2- qt? <br /> [3Unit <br /> 3. <br /> 4. <br /> "it 3 <br /> 6. nit 4 <br /> 8. El Unit 5 <br /> 01 <br /> Q unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> [jO UNDERGROUND TANK(UST)CLEANUP SITE(1.012) Q HOUSING ABATEMENT ❑SOLID WASTE FACIUTY/VEHiCL1r <br /> OTHER CLEANUP SITE(NON-LOP) [:1 Fool)FACILITY ❑WASTE TIRE 14p) <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)0,_, ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT )60q-tr <br /> El TIERED PERMITTED FACILITY [3 MOTELIHOTEL ❑PUMPER TRUCKNARDICHIFMICAL TOILETS <br /> EITATM/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> F-1 MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA13LE FOR REVIEW. MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List jCAQ_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 12 JZ021 fl4:QjZ8 or mSIL12 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 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$122 deposit prior to review. <br /> IND USP ONLY <br /> qjg-jo., I -7q 0 4-f4 i A h; z�ir Q 1-71 <br /> *6gEp q <br /> Ui <br /> 446V Vl,�b IAI;tl h, <br /> A <br /> EHD 48-o8 a I-wz OVA* fc�%vt% V.C. tfU Aq..' 0712WIi <br /> % ), <br /> kcA-U4--i' <br /> Loo/i.00ln 1t XVj L9:10 0I.Oz/cL/60 <br />