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DATE RECEIVED EHD LOG NUMBER <br /> � <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> VVV ( 1868 East Hazelton Avenue, Stockton, CA 95205-6232 � ' <br /> y elephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd fff <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ky" Q-. BUSINESS/AGENCY: ,,eeLl-e- 1�' <br /> ADDRESS: 33� S. ytl�e� e A.� �hL CITYISTATE/ZIP: Cho 12 (5A 7Q�e ' <br /> PHONE(1): 20(�s`�% 5_�-1t7 PHONE(2):ZO9 �� S JI FACSIMILE: ZO <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$13 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU IN SS DAYS <br /> SIGNATURE OF APPLICANT_-t}}--i ''(/`^-�-- DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> 1. 23�tc 5_ <br /> 2. . .N� F2 <br /> ❑unit, <br /> 3 z 3(r s9 S SFL�� RPS, n�R_z��e(�.6G.�1 r�tirleJ�lt�t,5�'A Itz <br /> ' ) 4. Z'3 0""C r""`"�`- V1 '/T ❑Unit 2H <br /> J 5. I 'LgZ.�6 - 15 <br /> _� ( �ClSSOW� C��' GtlCke- - N- <br /> 6. ( 7M <br /> 2 z (tJ SSp w� C' L.00 u`a`Y P-co � �3 <br /> 7. f-3tO hr, ( S% Lilcka r" nit4 <br /> 8. 'L`C 7o Ler "d' '7' 44 k^'M� I A N <br /> a 9. q l t �acY e Rd Coclrc � t,� <br /> h jC (i $ U(a?_ . L�+. k 13t Lus-_Lco? `2. W M <br /> Specific Date Range of Information Requested: From I to <br /> ENVIRONMENTAL HEALTH HEALTH DEPARTMENT FILES <br /> d'n NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK [:]CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKWARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ,POOL/SPA Ll LAND USE APPLICATION SITES <br /> ❑TATTOOIBOOY PIERCING COMPLAINTIRESPONSE RECORDS OTHER(PLEASE SPECIFY) G/'rtI( �C <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAIL LE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> 3. 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 /> 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$130 deposit prior to review. «BOXED AREA-EHD USE ONLY`*' <br /> 1"415-106 nen Csc o ,n (Oap 1141;5 C... 5 a F —e (J I �n l <br /> CO 17 'VI {4 Q_ 1 lJ 4' Cs 1 L ('! 00 J j KM (e Il RJ <br /> I X4&7_ CD. 1-4tdel tAS 4.1 W&Z. F-k $ cJ>. ATueICJ.ci� <br /> 13-R[a <br /> 11 Records povided tll RC "Staff Na6me: It <br /> EHD A"s <br /> tnHS <br />