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DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHO LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 AdL 11110111111111111h <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjg h <br /> PUBLIC RECORDS RELEASE APPLICATION r <br /> APPLICANT: 7 MCd11� ID C3 N ( 110 BUSINESS/AGENCY: eN G 0 <br /> ADDRESS: <br /> PHONE(,): 2c4 2 L City/State/Zip <br /> PHONE(2): ZO �FAC ' CA <br /> $ <br /> alp 9 <br /> TENTATIVE*APPOINTMENT DATE: l Z_ 0—() <br /> O <br /> (Please allow 10 business days from data a plication Submittal-"Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQU $905 F C H O ECM(ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name <br /> 1. G� / City <br /> uh <br /> 't U �, Y�9 � I- p W 1JJ ' Unit 9 <br /> 2. l v �k S�oC Sy. Ove? N0 C1 b,yD <br /> 3. © Unit 2 <br /> E o N, <br /> -q A. z> v co/-W <br /> v' 4. 1Z0 S. S�OCU+O , u9 T(-z) <br /> 6. -3 k4 5 065;lvocp(yQ Unit7. 4 <br /> 1 1 <br /> 8. 3 9 0Z) A)Dgy( Units <br /> - L \AS /s , <br /> 10. .� C4L�(.ST/'PA� AUE. � Unit 6 <br /> Specific Date Range of Information Requested:Prom �a.P�1�1 _ to PrL'3t kk <br /> ENVIRONMENTAL HEALTH DEPARTMENT PILES <br /> ,196NDEROROUNp TANK(UST)CLEANUP SITE(LOP) CI HOUSING ABATEMENT ❑ I <br /> X-OTHER CLEANUP SITE NON-LOP rj SPUD WASTE FACIUTYJVEHICLE <br /> ( ) FOOD FAcIuTY ❑WASTE TIRE Vim` <br /> 7a1,UNDERGRQUND TANK(MONITORINGJREMOVAL)P( ❑Doo KENNEL d OAIRY ��I <br /> =TIERED <br /> P R WASTE G FACILITY <br /> ORDe L7 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT � <br /> ❑TIERED PERMITTED FACILnY ❑MOTEL/HOTEL ©PUMPER TRUCK/YARDICHEM TOILETS <br /> Cy TATTOO/BODY M'IERCING ❑POOLJSPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLY-ABE SPZCIFY) <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 mail to the address indicated above. Address <br /> ranges will not be accepted,for additional assistance with file addrQsses,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!"HD 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 EHQ 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 /> EHD 48-08 8/04/08 <br /> PUBLIC RECORDS RELEASE APP FORM <br /> 10 39Vd NOdIaO39N3 SGLT66560Z Tb:TT 8002/LT/ZT <br />