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DATE RC, ll/ p., EHD LOG NUMBER <br /> SII � � SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT I' <br /> 600 East Main St- Stockton, CA 95202-3029 <br /> EIv�It,UfVP., _T6"hone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgoy.org/ehd <br /> 5 <br /> PkRDI,i f i5 P:V ES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: KvKten ?'%t; BUSINESS/AGENCY: &n MU16 &Ayvfcay tc, <br /> ADDRESS: WyA INamR r,. 4X SuAAlt C CITY/STATE/ZIP; 9aA,*A"i e gVLZ <br /> PHONE(1): (fit[,) 1t%Q-07.3b PHONE(2): (Sso) nt-Vi Ae FACSIMILE: ktC) 4eo -0603 <br /> TEN A !VE'APPOINTMENTDATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> [-]CHECK BOX TO EXPEDITE REOUES;�-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE !glll. <br /> Electronic Information: ❑ List ❑ Map- Description: <br /> FILE ADDRESS END USE ONLY <br /> Street M Street Name CRY M Uni(i <br /> 2• tel Unit 2 <br /> 3. t 1 <br /> 4- _jWX75 e� nH3 1 <br /> 5. Zta <br /> 6. <br /> 7. <br /> 8. ❑unit s <br /> 9. <br /> ::::# <br /> 10• ❑unHG <br /> Specific Date Range of Information Requested: From KICn to Firlstw(• _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIUTYAfEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARD/CHEMICAL TOILETS <br /> ❑TATT00/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-5:00PM(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 mall to the address indicated above. Address <br /> ranges will nut 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 filar will be held for a maximum of five business days for review. Appolnbnents <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 /> d. Any file not returned in the Some condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future Tile reviews by the same applicant may require a$122 deposit prior to review. <br /> ENO Use ONLY <br /> END <br /> 40-06 ""µitt WoJrAtiVslC\ � LUTsJAi lrwoRNv4wMaata"W ytuad%%. <br /> 1 <br /> L00/L00ln 1 u •� XVj L9:LO OLOZ/E1./60 <br />