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„ ,SEeENEDEHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 4 ?��1 ENVIRONMENTAL HEALTH DEPARTMENT cl <br /> or, ENVIRONMENTAL <br /> 600 East Main St. Stockton, CA 95202-3029 Cot <br /> (209)468-3420 Fax: (209) 464-0138 Web. www,sjgov.org/ehd <br /> PEM PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C'rygr�:v�. BUSINESSIAGENCY: nc,c.�+ �.,1f acs t — <br /> ADDRESS: 34i-34 ("'�,Pcer:, �1.4 �j� `�e C� CITY/STATEIZIP: �gc.roi-e-,4a,,�A 9s ) <br /> PHONE(1): V� Ll=- 7,� 2 PHONE (2): _ FACSIMILE: 17/ `7'S2.0603 <br /> TENTATIVE”APPOINTMENT DATE: ix,S"ljt Time: <br /> (Please allow 10 business days from date of application submittal-"'tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE RFQ EST-$1 2 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE .;g V-I I <br /> Electronic lnformatlon: 0 List M Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 0*4 1 <br /> HWY 5f <br /> 2- 6 O C> "T 5fot. t�I Unit 2 ; <br /> 3. W` 4 7 Z I a�� �, S t OC-S, 4? if3 <br /> 4- <br /> f) HOY 1 !1 )a No 640 e;,J unit 9 <br /> 6' .,TI/Unit 4 <br /> 7. <br /> 8. <br /> ._- ❑Unit 5 <br /> 9. <br /> 10, <br /> Q Unit Aul <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES hle <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILnYNEHI CLE I <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE f(/�l <br /> UNDERGROUND TANK(MONITORINGIREMOVAI.)-4 ©DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATORof^ ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT I I-3''t� <br /> ®TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SPIES <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. Lest 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 2 138 or mall to the address IndliggiLtd 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 flies 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 avallable. <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 /> EHU USE ONLY <br /> rat3 3� <br /> r 550 <br /> EMO 48-08 <br /> 07t2SM0 <br /> L00/tooln Xvi LL : LL 1-10VVZ/01. <br />