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Awl 8-08 13:58 Frog:-BROWN ANDjULDWELL 916 635 8805 7-759 P-001/001 F-537 <br /> = �`D f Ire EHD Lac NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www_sjg3vH7 <br /> 4 <br /> IV,,,;',z r;��s����+T HEALTH <br /> ;;,i. PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I l3u$INESSlAGENCY: VVW _ ,y <br /> ADDRESS: J t <br /> La � i3!r� � Ci lStatelZip +f �1 •C1� � ' <br /> PHONE(1). I(a� �,..� PHONE(2): FACSIMILE:'Al <br /> TENTATIVE"APPOINTMENT DATE: F 3 20 <br /> t Time: I:0 0 tf� <br /> 5 (Please allow III business days ffam date of plicati n subm ml-*Tsnta&4v only-must be confirmed) <br /> © CHE=CK BOX TO EXPEDITE RE EST-S1a E AS)i OR HECK NLY)-REOUEST PROCESSED IN 313USINESS RAYS <br /> SIGNATURE OF APPLICANT DATE / <br /> Electronic Information_ ❑List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 5treet# Street Name City <br /> F2. <br /> l0« � �r 1 rl r, <br /> [3 unit 1 <br /> y ✓Eyl'a`�yZ f- G �� tQ ❑ unit 2 <br /> -. 3. � W 1` <br /> tj <br /> W Unit 3 <br /> 5• Off j L> f G y�P��' unit 4, <br /> NWf t4 <br /> 7• 0kl.ir�yl�` � ❑ unit 5 <br /> S- 1 [I unit 6 <br /> % 401 0, Lj <br /> Specific date Range of Information Requested: From � C� � �Iql 0� to <br /> ENVIRONMENTAL H>=ALTH DEPARTMENT FILES <br /> UNI]ERGROUND TANK(UST)CLEANUP SITE;(LOP) 17 HOUSING ABATEMENT Ca SOLID WASTE FACILITYlVEFIICLE <br /> KOTWER CLEANUP SITE(NON-LOP) E3 FooD FACILITY 17 WASTE TIRE <br /> UNDERGsRWNDTANK(MONITORING/REMOVAL) i3 DOG KENNEL 0 DAIRY <br /> � <br /> HAZARDOUS WASTE GENERATOR 13 4YlICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PFRMrTTED FACILITY 0 MOTELIHOTEL ❑PUMPER TRUCKIYARD(CHEM TOILETU <br /> R TATTOotBoDY PiFRcING E7 POOLISPA C]LANA usE APPLICATION SITES <br /> I3 MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPEGI ) <br /> WELL AND SEPYIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MOND Y-FRIDAY 8:00 AMZ:OUPM -EXCLUDING HOLIDAYS_ <br /> 1_ List up to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464-4 38 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 FHD 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 suhedulod accordingly. <br /> 3. A file that is actively being worked on by EIRD staff may not be immediately available for review_ A now application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will bo rear sized by EHD Staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$105 deposi I.prior to review. <br /> EHD USE ONLY <br /> EHD48-06 8/W08 PUBLIC RECCF405 REk£ASEAPP FORM <br />