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Mar ` 3=,H-H-1'4: 1$ BR N &_WINTFRS — No S417 P. .. 7 <br /> - -- -- - - - <br /> prEHD LOG NUMBER <br /> I_�` SAN JOAQUIN COUNTY <br /> ENVIRONMI<NTAL HEALTH DEPARTMENT <br /> 10AR ' 200" 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468.3420 Fan. (209)464-0138 Web:www,sjgovq_ hj <br /> EI1�UlF��1I�j,��EV� ,����PER'll 1 ,SEr ,�,ES tPUBLIC RECORDS RELEASE APPLICATION' <br /> T: �.+l�Mef /19f�7_Mf0A/ BUSINESSIAGENCY: &?Vk/N d6WlvT"f <br /> AD Ss: ao 6 f fer"i IV G I+A4M m v e teop CM024)c C4� 9,-.Cao 7 <br /> P NE(1): 7-&10 &71~9We� �— PHONE(2): ��D I �I. p-FACSIMILE: �fG 3 f yi{-Z7 <br /> TENTATIVE*APPOINTMENT DATE: �f R C-* /& Zt Tuna: <br /> (Please allover 10 businas ays from data of application submttal-'7P_n_f v@ only-must be confirmed) <br /> CHECK BOX TO EXPEDITER EST•#'I0 FEE H 0 CK NL-1)-REQUEST PROCESSED IN S BUSINESS DAYS � <br /> GNATI#RE OF APPLICANT f DATE <br /> 'lectronle Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD IJ39 ONLY <br /> Street 0 street Name City <br /> E /V, Olen,7-C S7-,;E - r)-ock Unit� <br /> srm� C'PCs (P 4L.4 s-034II ❑ Unit <br /> a, , S7_CX1fW,c.15r %" ck Aw u�i:a <br /> �p Ulnt 4 <br /> 7. <br /> ❑ Units <br /> B. <br /> ❑ Unit 6 <br /> L10 <br /> SpecifWl)ate Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> WUNDVIkGROUND TANK(UST)CLEAMOP SITF(IAP) ❑Hoama ABATEMENT 0 SOLID WASTE FACILITYNEHICLE <br /> t3 OTHER CLEANUP SITE(NON-LOP) CI FOOD FACILITY E3 WASTE TIRO <br /> ; INDERGROUNO TANK tMONITORINGIREMOVAL) 13 Doc IKENNEL 0 DAIRY <br /> D HAZARDOUS WASTE GENERATOR O 0mC.IaEm RAxCH 0 WASTEWATER TREATMENT PLANT <br /> 17 TIERED PERMITTED FACILITY C]MOTELIFIOTEL 17 PUMPER TRUCKIYARDICHEM TOILETS <br /> G TATTOO1500Y PIERCING C3 POOLISPA 17 LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 17 OTKER(PLEASE SPEC] ) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDA -FRIDAY 8:08 AMd:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of file from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464-01 8 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file add re ses,Contact the EHD. Applications received after <br /> 1-00 pm will bs processed the next business day, <br /> 2. The EHD will notify the applicant If any EHD files exist An appointmc nt for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that Is acuveiy 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 tha same condition S$raloased will be reorganized by EHD Staff at the sxpansa of the applicant <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 46!16 B/D4108 PUBLIC RECQRQS RF1 FRSE APP FORM <br />