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DATE RECEIVED <1 EHD LOG NUMBER <br />U �1 ►��", SAN JOAQUIN COUNTY <br />I / ENVIRONMENTAL HEALTH DEPARTMENT R <br />a <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232.E <br />IG .;. .;` <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd f <br />a <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: �vis(ch �„��' BUSINESS/AGENCY: <br />ADDRESS: 3°{oP <br />_('t SIVA rJe. 7,00 CITYISTATEIZIP: <br />PHONE (1):(_oto gcks_ 5-1-14 PHONE (2): FACSIMILE: I fA <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 />D , ) vJ F IIE- <br />FILE ADDRESS <br />EHD USE ONLY <br />Unit 1 <br />-,r1.� le 7�,u, c >✓C oa �c`✓I <br />Street # <br />Street Name City <br />1' <br />to to <br />usivitcl� 4,+r` <br />t�1 Rr iNMP i WAP <br />NM Nva IA C,C O'lnit2 <br />2. <br />t�zl <br />3. <br />'�Sv <br />MMP 3�J u 1) NcCOS� <br />Unit 3 <br />4. <br />160 <br />5. <br />fast <br />S <br />/r <br />F <br />fps +�P 6A cr5p <br />/ _- <br />E],_, <br />Unit 4 <br />6. <br />7. <br />rqrrn <br />❑ Unit 5 <br />8. <br />9. <br />11 -Unit 6 <br />10. <br />Specific Date Range of Information Requested: From I `acro to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES I ht�e7 <br />EINDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑MEDICAL WASTE FACILITY RSOLID WASTE FACILITYIVEHICLE U <br />216THER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT WASTE TIRE (� <br />[�JGNDERGROUND TANK (MONITORING/REMOVAL) ❑ F .OD FACILITY [a'ISAIRY UIUr I`� <br />[--ABOVEGROUND TANK HICKEN RANCH/ DOG KENNEL D WASTEWATER TREATMENT PLANT{t'CO <br />ED- AZARDOUS WASTEIHAZARDOUS MATERIALS L]MOTELIHOTEL ['PUMPER TRUCKIYARDICHEMICAL TOILETS `' <br />21IERED PERMITTED FACILITY DfOoUSPA [ CAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING ['COMPLAINT/RESPONSE RECORDS ['OTHER (PLEASE SPECIFY)�� <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 $130 deposit prior to review. *"BOXED AREA- EHD USE ONLY` <br />-�C1 11DqI <br />D , ) vJ F IIE- <br />0-Ci'rS <br />-,r1.� le 7�,u, c >✓C oa �c`✓I <br />s .ti '` 177 t <br />i iC /it rt -05 c :r5} vag1,9A$ oz&- 4 X5j CZ c`yUi 2 <br />)iS� r q V %_,_ /C ZI /✓1�c,S�Tn <br />eHuas-0s c/Ic7U <br />inudt,Itrer -V aill3 <br />j02.1 I.1clu�i'ia.� 01I9�d16A Inc <br />a50 ,rfdk_5i7'tat 15 Hle lost <br />J <br />R 'Nvo 1,trlu�Trial ° °0rZrid_ct U ,4 j,- <br />c osotita • j <br />l�i� F'o•� ISD /rlducJ <br />! I <br />d cern r?utur�s� �� ISS) s�zrr}� , �:-r�a�ci�k to c� ��vc> f✓tdcrstrial <br />Spe.-rte AsT dc -9L. -to. T%S s U)4 Ief u) FO r 7&z , eLct LiEt-1co d.v_u_ fr- <br />