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RECEIVED SAN .JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> I�tff Z 2 2011 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vvww.sjgov.ory/ehd t <br /> ENVIRONMENTAL HEALTH <br /> P iLPiIT SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> ('v-egf <br /> APPLICANT: G[/�Gy� re f BUSINES /AGENCY: .dam t5�"Yte- <br /> ADDRESS: 18777 ©,..,� .c Cl CITY/STATE/ZIP: i _ CA (95'2seb <br /> PHONE (1): Z:PGi • 36V•- &.60a PHONE(2): FACSIMILE: c.49• 349 . 4-8.23 <br /> TENTATIVE`APPOINTMENT DATE: Ada 3/1 Z0 /e _ Time: �a� • �cm�' ��:t <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASHQR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT - I � _ .-_ , DATE z° ' Z- <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. s ' eiL%� /11,f�veG✓ 'c4;,# i JfIC���' © tt�J ' 1;1 <br /> 2. / <br /> — - - �Unit.2. <br /> 3. r I <br /> 4'.-�.. nit 3 <br /> 5. <br /> 6. <br /> Unit 4 <br /> 7. <br /> 8. <br /> - -- --- ---- --- - ------ 0 Unit 6.. <br /> 9. <br /> 10. <br /> El Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> � ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> C36NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE )61'65 <br /> ER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVALV�_ ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR C\ ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT 3 a (( <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOOMODY PIERCING ❑POOL/SPA ❑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$122 deposit prior to review. <br /> EHD USE ONLY <br /> 100 LSIQ DINNI HDQIN9000M EZ9969£609T YVd 9£:9T TTOZ/ZZ/£0 <br />