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EHD LOG NUMBER <br />rff._� <br />;1'SAN JOAQU! COUNTY <br />\\ j�t- ,L1 �J Imo.,__ <br />ENVIRONMENTAL HEALTH DEPART�N$ <br />600 East Main St. Stockton, CA 95209 <br />,ra; J hone: (209) 468-3420 Fax: (209) 464-0138 We w4�w.Sjgov.org/ehd <br />L i', ',--ER 1(B PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: 1: I .x-21 - o BUSINESS/AGENCY: <br />ADDRESS: C 2CO CITYISTATElzIP: C65f k <br />PHONE (1): 5 0— CP PHONE FACSIMILE: FACSIMILE: 51U--Z��S- 265(� <br />TENTATIVE* APPOINTMENT DATE: Fri cAO Jmoi' `J 2 , 2 d) O Time: A Yy( <br />(Please allow 10 business days from date ofap ca iot n submAtai- 'Tenta�velyo must ust be confirmed) <br />HECK BOX TO EXPEDITE REQ T - $115 SH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUST ESS DAY <br />S <br />SIGNATURE OF APPLICA DATE 7-S <br />Electronic Information: 13 ListXMap _ scription: _ lb✓r O n ",TL7 1,✓1 <br />FILE ADDRESS EHD USE ONLY <br />Street # Street Name City ❑ Unit 1 <br />1. 2-01 45- -V I- St vJ U+," -r oZ No cv <br />2.- 1, O U`S S 9��Unit � <br />3. <br />4. =c <br />0 i C- Unit 3 <br />5. ILA -Tb �9 <br />6. ZZ3 ' y e�yl Z/� v9 �? % 1 Unit 4 <br />150 1 �J±jc_�<_ ne- 0 6-t� I Lo/'� r <br />8. 102-2, ' �?�1% %� e C� • -W i�C �J G� % i" p Unit 5 <br />9. <br />2-39 <br />10. V unit 6 <br />Specific Date Range of Information Requested: From L' • torp, -} <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE � <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY WASTE TIRE i• <br />J,NDERGROUND <br />TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL F1 DAIRY ie f <br />AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH WASTEWATER TREATMENT PLANT i <br />ERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />❑ TATTOOIBODY 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 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 $115 deposit prior to review. <br />5. If you need further assistance, please contact Diane Martinez, at (209) 468-3425. <br />ri4n 1100 rml V <br />r <br />y.._ � .�/.i A... a..:�♦)1�4�ti��1 1fI/11� l%J(/i /, ��/I i+;� <br />pry(��.i .._ <br />� .� � .. ,/% /,` �..� - ����.f�/L����,.�1i1•i'. J� f/lflawwr���L�,�i/1!���l.J� / i /y.. <br />r <br />