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UU/1414VU1 1V:4U VAA Q002/002 <br /> - EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> gL ��7 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> ' Telephone: (209)468-3420 Fax:(209)464-0138 Web: ZI 15 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: i �(1cQ. - ���?�I���OS BUSINESS/AGENCY: <br /> ADDRESS: '140 `k t-kot-le"g_ L4 �S7vOcioFA I C.,� CtS ZI� <br /> PHONE(1): ��22— PHONE(2): FACSIMILE:�2"� <br /> ,,.✓ TENTATIVE APPOINTMENT DATE: Time: ' 4 <br /> nor (Please allow 10 business days from date of application submittal-*Tentative only-must be confirme <br /> �� CHECK BOX TO EXPEDITE REQUEST- .00 F0 CASH 0 CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> �RV <br /> SIGNATURE OF APPLICANT DATE '� 1 �—;2-- <br /> UNDISTRIBUTION 0 Un ❑ Unit 2 <br /> IT L7 Unit 3 ❑Unit 4 ❑ Unit 5 0 Unit 6 0 Other(electronic/lists/maps) <br /> FILE ADDRESS \ EHD USE NLY { <br /> Street# Street Name City , <br /> 1 t{I d O ST, <br /> 2. 4�. _ L)u earn .(c tU <br /> _ . �• <br /> 3. 5Rod <br /> 4. E. Com,-pw� - R� S�} Nu'6,3Tpp <br /> 0 -�F <br /> _ t , <br /> �. <br /> 516 <br /> — - , t'rr►�T ''f6. <br /> ANli - ' <br /> IA(LdY •�� <br /> 8. <br /> 9. <br /> Specific Date Range of Information Requested 0 ,-`,a <br /> ENVIRONMENTAL H ILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ATEMENT SOLID WASTE F gLITY/VEHtCLE <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY 0 WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL 0 DAIRY <br /> ,HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PIERCING 13 POOL/SPA ❑LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY d OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-6:00PM - 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 da sh. <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments stfould 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD 48-02-006 - <br /> V14105 <br />