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Jul UD ut 11:1ba Apex 209 667-9668 p.1 <br /> L--OAT-��M D SAN TOAQUIN COUNTY � EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`4 Floor, Stockton, CA 95202-2710103 Telephone: (209)468-3420 Fax:(209)464-0138 Web: www.sjgov.c.5 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1J Ce-� 4�n ��`�,� BUSINESS/AGENCY: Apex <br /> ADDRESS: 34U 14 N• ( ,:�i.tk, S{a� 131 - S�Ik L T..1v19 to 4S36 Z, <br /> PHONE(1): q (off 8 4�{ PHONE(2)(' Z-oq `�' -Z�-SZ FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: �JZ I O� Time: <57(Do <br /> (Please allow 10 bUsiness days from date of application submittal-'FentaSve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 7 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Elec tronic information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City / ❑ Unit <br /> El b'nr.A4 SSE FVt.Z1 tfAllr <br /> 2• 1139 N, l��yh ,o q5 (od �021� �� ❑ Unit <br /> 3. X555 W, 1a¢w + er Lolfl sk.�Ck�n <br /> 4. ill �ctr�TA WG S�ck�� ads IL ❑ Unna <br /> 6. qqo-+- G- t„) a�f„rLoc, 12pc d Unit4 <br /> 7. V <br /> a ❑ Unit 5 <br /> 9. <br /> 10. ❑ Unil(I <br /> Specific Date Range of Information Requested:From to <br /> �,/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Int UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLM WASTE FACILITYIVEHICLE <br /> C1 OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑WASTE TIRE <br /> O UNDERGROUND TANK(MONITORWGtREMOVAL) ❑DOG KENNEL 13 DAIRY 1 <br /> O HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER IRUCKIYARD/CHEM TOILETS <br /> Q TATTOO/BODY PIERCING 17 POOLISPA Cl LAND USE APPLICATION SITES <br /> C3 MEDICAL WASTE FACILITY ❑OTHER(PLEASESPECI(Y) <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 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 rive 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD9B-0e all Q <br />