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E ,. � " NUMBER GATE SAN JOAQUIN COUNTY INV o 4 ENVIRONMENTAL HEALTH DEPARTMENT=� L Z�1 1868 East Hazelton Avenue, Stockton, CA 95205-6232 (209) 468-3420 Fax: (209)464-0138 Web: www.sjaov.org/ehd envE � PUBLIC RECORDS RELEASE APPLICATION ff N VOW IqSH APPLICANT: BUSINESS/AGENCY: ADDRESS: P(iCITY/STATE/ZIP: PHONE (1): k�I "ZLI -6 kJ l cPHONE (2): _ _ FACSIMILE: Please allow 10 business days from date of application submittal for the records to be available. Staff will contact you to arrange an appointment date and time to review the requested records. CHECK BOX TO EXPEDITE REQUEST-$125 FE ASH OR CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE Electronic Information: ❑ List ❑ Map—:—Description: _ FILE ADDRESS EHD USE ONLY Street# Street Name City ❑Unit 1 2. cl cl o l t cc l ❑Unrt 2 00 cr> 4• I Unit 3 5. Q 7 �+ t 1- 8. ❑Unit 5 9. 10. ❑ Unit 6 Specific Date Range of Information Requested: From to ENVIRONMENTAL HEALTH DEPARTMENT FILES _ { s �G�IDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE •5 UI�� OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE t 3 Pit ERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY UX-1-7'. GROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT gIAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS rev ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES ❑TATTOOIBODY PIERCING ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) 1 List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address indicated above. Address ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant. Future file reviews by the same applicant may require a $125 deposit prior to review. 'BOXED AREA-EHD USE ONLY*** w') ' i c i L IQz ,spj 1zzc5 Z� 2�. -W35if �nLga 0 I is(L,*nW z h,fcr Pic) Accor i 'o.5 /7SE X5J-CC7__ A'_i�C'G`S�:.Z Ci3t njA&f. X�iJC+4•{il X`"Jr�4 ' XSj (�%7' _ . ASJ C"ZLI)9'�02c XS.1 ki�C��t4.bS s X,S.IG l t�`hj�JY�-+1-.^. + ntP4 [i 2 atSJ Fe#5i+ xs3OZlyl�X5+1 ozi5j, Xv O,zz97/ )(Sj OdJZ,3,AjG2�33� rsJ 02)32, Xsj �d]yjNi4/5jDZY4 .X 51 C3z.y7.o )tS.� 0 3 525.1 x sj t yi-- X QM V k-04 Ch e4- A96 P.cc,';, r tsr Msla 1U A ronx+-n1' 44-