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0 HOUSING ABATEMENT <br />1:1 FOOD FACILITY <br />El DOG KENNEL <br />El CHICKEN RANCH <br />0 MoTEUHoTEL <br />PoOL/SPA <br />ri OTHER (PLEASE Specirt) <br />0 SoLio WASTE FAciLITYNEHICLR <br />Ii WAsTEDRE <br />DAIRY <br />WASTEwATERTREATmENT PLANT <br />O PUMPER TRUCK/YARD/CHEM Toit.eis <br />0 LAND us E APPLicATiou S ars <br />DATE RECEIVED <br />IST.;e'\ <br />EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />5 210 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/e d <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: ni 51/0.4 MAIL- <br />fr <br /> 6 LI-L0e4 L3-1 BUSINESS/AGENCY: S.IEZO_A 1 (6C,Ftleirl-te-AJ <br />ADDRESS: 9)10 St Ve't5L <br />PHONE (1): (Scc-i) /7,d't - IL( sj PHONE (2): FACSIMILE: (SS GI) ri - I L•151.- <br />TENTATIVE* APPOINTMENT DATE: OattUr -.t)t)t Time: -l\ p5J <br />(Please allow 10 business days from date of application submittal -"Tentative only - must be confirmed) <br />City/Stdteaip c0.51-.)0 ,LA 1311c5 <br />El CHECK BOX TO EXPEDITE REQUEST - 810 <br />SIGNATURE OF APPLICANT <br />CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />DATE 101108, <br />Electronic information: LI List D Map — Description: <br />FILE ADDRESS EHD USE ONLY <br />Street # street Name City <br />1_ <br />...., . <br />,%7>' <br />/ <br />/',...' <br />— , :-/, --)(") <br />0 Unit 1 <br />1 - 4 1,15 . wita-eluzo VIA° 51'0 1.04X-+-) <br /> 0 Unit 2 <br />-.1 4 <br />Unit 3 <br />_ <br />6. Unit 4 <br /> <br /> II Unit 6 <br />8, <br />Unit 6 <br />10. <br />Specific Date Range of Information Requested: From to <br /> <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />S] UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />Cil OTHER CLEANUP SITE (Nou-LOP) <br />RI UNDERGROUND TANK (MONITORINCIIREMOVAL) <br />I a HAzArtoousWAsTg GENERATOR <br />TIEFtED PERMITTED FACILITY <br />TATToo/BoDY PIERCING <br />El MEDICAL WASTE FACILITY <br />WELL AND SEPTIC PERMIT RECORDS AFtE AVAILABLE FOR REAtim - M0NDAY-FR1DAY 8:00 AN-5:00Rm EXCLUDINO HOLLDAYS. <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 selecte-d. Fax to (Ng) 464-0138 or mail to the address Indicated above. Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the END. Applications received after <br />3:00 pin will be processed the next business day. <br />Z. The El-ID will notify the applicant if any END 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 />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 />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 />cl <br /> <br />2q+,T-822-BSS-T 01Jo3 u-4Taci eJJaIs <br />ei7S:TT 80 .171 '400