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DATE RECEIVED <br /> SAN JOAQUIN COUNTY END LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjg h <br /> 0 <br /> ^^PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �IG�>�2� CS NDOLh0 r <br /> BUSINESS/AGENCY: �N Ute U <br /> ADDRESS: 510WI'114 A Cltyl$tate/Zip Cp- 9S <br /> PHONE(1): '2,G4-1 GILL-4 6 04 PHONE(2): 204 21 6 b S <br /> FACSIMILE: <br /> TENTATIVE*APPOINTMENT BATE: (7.- 0-0 <br /> �: O <br /> (Please allow 10 business days from data a plicatlon submittal-"Tantat/ve only must be confirmed) <br /> CHECK BOX TO EXPEDITE REQU $105 F C HO ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE —7 /7- Q <br /> Electronic Information: ❑ List 0 Map 4 Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. <br /> -�u � Unit 1 <br /> 2. t L S6ckion Say. Ave? No 6,11:? <br /> 3. © Unit 2 <br /> E o '�,�. Z-), o c C iv ; <br /> 4. Z 0 $ S�FnCLttU., /�4t. U5 T�z) o C SI,vJ uY� .t tura unit s <br /> 6 'j14 u5 pES�N0W(q Unit <br /> 7. 3 L( <br /> s. I <br /> 33} L� f', 9 OZ) E3' n10 lq9��' 0 unit s <br /> 9. - L n e us �- <br /> Q [) Unit 6 <br /> 14. 22 L &134re'a IAVG UriYr�! ti No(G T <br /> Specific Date Range of Information Requested:From 1I$7 to <br /> / ENVIRONMENTAL HEALTH DEPARTMENT FILES n� <br /> y{ 1 ! <br /> fM-UNDEROROUNp TANK(UST)CLEANUP 51TE(LOP) ❑HOUSING ABATEMENT ❑ I\ <br /> X OTHER CLEANUP SITE NON-LOP C] SOLID WASTE FACILITvIVEHICLE <br /> ( ) FOOD FACILITY ❑WASTE TIRE V•" 1�I <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DoG KENNEL ❑DAIRY n_ <br /> ,0—HAZARDOUS WASTE GENERATORoc 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> Cl TIERED PERMITTED FACILITY ❑MOTEL/HOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 0 OTHER(PLLA&E SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILAULE 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 209 464.0138 or mail to the address Indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD. Applications reeelved after <br /> 3:00 pm will be processed the next business day, <br /> 2. The I=HD will notify the applicant if any 1MHO flies 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> r -a ,M 11 4 <br /> '11 Ajja 5 �A,1,1 h <br /> 3� + to <br /> ani E s <br /> �'s I� <br /> EHD 48 06 8/04108^ <br /> PUBLIC RECORDS RELI=ASE APP FORM <br /> TO 39Vd NOdIaD39N3 56LTGGSHZ TV:TT 80H/LT/ZT <br />