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-T-1r� <br /> R4 'r" V L—U <br /> E LEHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> AUG Ono �u5 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ,NrjR0Ni,1IENTAL HEM-TH Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehde4oq ,4 (0 <br /> pF-rMIT1SER,1GES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1�01CAIID mllla'/l BUSINESSIAGENCY: �L ('o gldhtfIG� -+ <br /> ADDRESS: 20-( i u, '�+,P e 310 CITY/STATEIZIP: (�-Mlhn-fqSLOLJLI ' [-to <br /> PHONE(l): 4�L-S-L1 ,4zo-2- PHONE(2): FAXORE-MAIL: A1411tijQA& <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 /> El CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED 114 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ') I DATE -1/?"-?I b <br /> 1. List up to ten addresses In the space below. Select the type(s)or files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the address d 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 I released will be reorganlied by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic information: 2'List[] Map-Description: <br /> Specific Date Range of Information Requested: From T-jrS-j cAva I(QbLe to M(fsell ( <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS EHD USE ONLY <br /> FILES <br /> `U-DERC>lAUNS TANK(UST) Street# Street Name City <br /> • CUANUI SffE(LOP) r <br /> 26HERCLEANUPSUE(NDH-LOP) 3301D Wes4 Cvu±ij Cluo lo UJ - S hw/.1m) 19 <br /> 31�--RWMS WASTE ❑D'S., <br /> �afERE D PFFQU=D FACNTY 2 <br /> Z-AaavecPouND TANK PWS <br /> 'GST (MoNmowNG I REMOVAL) <br /> Z-HA-RWUS MATERIALS 3 <br /> �-JRELEAsE RESPONSE <br /> L; WALED OJALT' <br /> F1 SOLID VVAErE FACIUW/VEHICLE <br /> ❑FWD FACIUTY <br /> ❑POOL I SPA S"MmK;A'.N <br /> ❑DMW D(M 1 g-f -JQ tit/I <br /> n LAND USE APPLICATION STIES <br /> -ETS-MC PUMPER TRUCK I <br /> YARD I CAE60CM.TOfl-ETS <br /> ❑WASTEWATER TREATMENT PLANT WCUPA <br /> F1 HOUSING ABATEMENT 7 <br /> ❑MOMLIHOML <br /> ❑CHICKEN RANCH/130C KENNEL ircUPA-UST <br /> ❑MEDICAL WASTE FACILITY <br /> ❑TATTOOIBODY PIERONG Q <br /> ❑WMTETIM <br /> ❑OTHER(P-EASE SPECIFY): 0 <br /> -BOXED AREA-EHD USE ONLY- <br /> • <br /> 0 Records provided by Staff-PPR Complete. start N-me: <br /> EHD4a-06 <br />