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D1IMYdW EDO <br /> Cr� '11117 SAN JOAQUIN COUNTY <br /> EHD LOG NUMBER <br /> I t 2009 ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029ENVI (M(MEERHC gj�lephone: (209) 468-3420 Fax: (209)464-0138 Web: WWW.sjgov.opER9Z95% <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I N �, 0 r_ BUSINESSIAGENCY: F—�'S6 c) <br /> ADDRESS: n C-00 N. w� tt 10td- Ayf- Jh,, Q city/5tatelzip <br /> PHONE'(1): 2,VM � --rY KR � PHONE(2): VA .0v - 2G&.r FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE; AAPro' E-1 7'00q Timo: U 30,11`^ <br /> (Please allow 10 business days from date of application submittal--Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE RE T- Of EE(CASH OR CHECK ONLY),REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> -�. E] Unit1 <br /> G� ST ,o aJ F, F <br /> 2. W. t Se Ma eca q4, 6 ',)Ic o ❑ Unit2 <br /> N. m e . <br /> 4. aao __: DnR3 <br /> -°ate _� G <br /> q-111 51 3 <br /> A $1 -... ... , 9_S.C�.- . 5 nR <br /> .2 tr, T M W7 sa 5aff_ <br /> -aaa 0 Q(y <br /> units <br /> g. sUnits <br /> 10. Lin colas. <br /> Specific Date Range of Information Requested:From Cer•II[1}. to x464 /`. c"'+ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> /,�Qr UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 173 SOLID WASTE FACILITYNEHICLE <br /> XCITHER CLEANUP SITE(NON-LOP) C7 FOOD FACILITY 0 WASTE TIRE <br /> eYKUNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL C7 DAIRY <br /> OHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARUtCHEM TOILETS <br /> TATTOO/BDOY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY C3 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 12051 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 mceipt of application. The files will he 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 $104/03 PUBLIC RECORDS RELEASE APP FORM <br /> ze/te-d 6610 998 SZ6 T Q31bHDdd0DNI DEON3 ££:9T 600E->z-add <br />