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�� irIVEDi1 7- EHD <br /> - EHD LOG NUMBER <br /> I� <br /> TPI <br /> J SAN JOAQUIN COUNTY <br /> LQ <br /> ENVIRONMENTAL HEALTH oNt 01 <br /> L� 600 East Main St. Stockton, CA 9520 <br /> ,�ephone: (209) 468-3420 Fax: (209) 464-0138 Web.I WZjgov.org/ehd <br /> L s � iPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: l 1' ` . '� BUSINESSIAGENCY: <br /> ADDRESS: S I 1'1 S+e ZC0CITYISTATE1ZIP: CcU 5+6^ <br /> PHONE (1): PHONE FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Fri Ck0. ; 2- 2 U U Time: ArvA <br /> (Please allow 10 business days from date of app ca ion sub I-'Tentative only-must be confirmed) <br /> )ZKHECK BOX TO EXPEDITE REQ T-$115 SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUST ESS D YS <br /> SIGNATURE OF APPLICA DATE <br /> Electronic Information: ListXMap— scription: tp u 1�1r ✓1 �e <br /> FILE ADDRESS e� j EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1. 20 1 �fih t -� oZ No -- — <br /> 2. �— C u�� S� ---- �;f J '�\'��SiUnit2 <br /> 3. <br /> 4. Unit O\'1 _ 1 _ Unit 3 <br /> 5. 3 -3 J- <br /> LOA f <br /> 6. Z2S GL ��✓1 1'}Z �a� Unit <br /> 8. 02-2, Pro r4acw C3 _ u +W— A GJ w 1• � D Unit 5 <br /> 9. 2 3 S,S C 5fi. u�-f 1065 o �o�y <br /> 10. 1 1 , . XUnit6/1 <br /> Speck Date Range of Information Requested: From Ll 7 i 7 to <br /> NO ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> lKfUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACIL(TYNEHICLE <br /> (7�+ OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE ��/ I <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY ✓V let <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT r <br /> f vNe <br /> IERED PERMITTED FACILITY ❑MOTELMOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> Q{v`" ❑TATTOO/BODY PIERCING ❑POOLISPA ❑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)4640138 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$115 deposit prior to review. <br /> 5. If you need further assistance, please contact Diane Martinez,at(209)468-3425. <br /> EHD USE ONLY <br /> 3 — N, <br /> E✓ � ll'1;' ti's Ji ' .67 <br /> CZi tA 0, lttA <br /> J <br /> 17� <br /> E )48 <br />