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t <br />DATE RECEIVED ,EHD LOG NUMBER <br />jE SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, -t <br />I e, Stockton, CA 95205 6232 � <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />a <br />. PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: &s(eh �iN,' BUSINESS/AGENCY: Pn1 F�vtrvv.wle.i3Ot lNc- <br />ADDRESS: 3'{oa �,h int Plvet ske• ?oma CITYISTATE/ZIP: <br />PHONE (1): PHONE (2): FACSIMILE: dA_ <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 - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT /- DATE <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE 014LY <br />10 Unit 1 <br />Street # <br />Street Name <br />City <br />1'Lo <br />%o <br />uttri <br />4 ,� <br />Alt+.- +nn►ryP + cosp <br />�' (►� r+� I ccs, p'u t2 <br />z. <br />tit <br />3. <br />'lSo <br />ti:MP +uJ �+I) NcCns f' <br />t�S ,> r s,u, Unit 3 <br />4. <br />-16o <br />5. <br />laSl <br />ODf ❑ Unit 4 <br />6 <br />Y <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />❑ Unit 6 <br />10. <br />Specific Date Range of Information Requested: From I `1m to n,<twk <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES `D hl�e5 <br />�1NDERGROUND TANK (UST) CLEANUP SITE (LOP) ['MEDICAL WASTE FACILITY Q -SOLID WASTE FACILITYNEHICLE U <br />�THER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT Q -WASTE TIRE (� <br />2tNDERGROUND TANK (MONITORINGIREMOVAL) ❑ F .OD FACILITY Y AIR�,Il <br />EJ<BOVEGROUND TANK ICKEN RANCH/ DOG KENNEL OMASTEWATER TREATMENT PLANTIt'C_# <br />�AZARDOUS WASTEIHAZARDOUS MATERIALS �❑—y �MOTEL/HOTEL g1PUMPER TRUCKIYARDICHEMICALTOILETS �2' <br />211ERED PERMITTED FACILITY DfOOL/SPA [a'CAND USE APPLICATION SfTES <br />❑ TATTOOIBODY PIERCING [31COMPLAINTIRESPONSE RECORDS [•'OTHER (PLEASE SPECIFY) R6 oaOS �� <br />WELLAND 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) 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 />41s� <br />EHD 4M6 ' r / lv 7L - 7lvL' ictclu�ri iu l OB 61114 <br />inGciGlfrpr x5.j cill3 , x 5J i rvride.ct u/r! l .M �:' 8577 Endo iaL <br />f � <br />iv.2j •�rdu_16-1a_f (/ned. <br />yiol) /•7c d Cern >�/urts) t 1�SI Sperry , Paiidi2dA, c:© q -7&c) lrtdq-4iled -c1ST )(k3 <br />q_50„�dust7-auk usT Hie tom} Spe.-rq AG; �;1e_., ciu--io /Ss UjA ►� For- -7tto d-i-ft7 <br />\o .� <br />- - } O ,. Lille— <br />_p- <br />"le -7C-,(3t r I G^ D�I lo5i <br />s v ) 77 <br />()(e <br />HQ� P2J ( a GI } r�S AS0 -0097q/ <br />XS p/ate XSd 017L 1�r' 1010 i,1 <br />bixi[ �9f t 5 c :rSJ ra4i�j x�� 0..� XS�Cz� , <br />KS (),IV() PC r lczl /�7clu_1f7-l:�. <br />41s� <br />EHD 4M6 ' r / lv 7L - 7lvL' ictclu�ri iu l OB 61114 <br />inGciGlfrpr x5.j cill3 , x 5J i rvride.ct u/r! l .M �:' 8577 Endo iaL <br />f � <br />iv.2j •�rdu_16-1a_f (/ned. <br />yiol) /•7c d Cern >�/urts) t 1�SI Sperry , Paiidi2dA, c:© q -7&c) lrtdq-4iled -c1ST )(k3 <br />q_50„�dust7-auk usT Hie tom} Spe.-rq AG; �;1e_., ciu--io /Ss UjA ►� For- -7tto d-i-ft7 <br />