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DATE RECEIVED EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />' ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232` <br />WT <br />elephone: (209) 468-3420 Fax: (209) 464-0138 Web: vvww.sjgov.org/ehd <br />\�v <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Mt) r--(vm , )V 6'� BUSINESS/AGENCY: 1-44v 1(?- CC , � ��rn (r'Vc - <br />ADDRESS: 7 Gv U Z -k 57-6- (o CITY/STATE/ZIP: P-4.4:5� Y1 L L eI <br />PHONE (1): �a/t�i5 `�Sr! �� S 3 PHONE (2}: y'fL ) v vU -- S 6 Gam; FACSIMILE: <br />TENTH IVE* APPOINTMENT DATE: is P4. , t� Time. <br />(Please allow 10 business days fromAhte of applica ion submittal - *Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - F A OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSI ESS AYS <br />SIGNATURE OF APPLICANT DATES /_� <br />Electronic Information: ❑ List ❑ Map - De ption: <br />FILE ADDRESS <br />EHD USE ONLY <br />7l > l <br />Street # <br />Street Name City <br />7. <br />�� <br />r , � I W �} } 4 r✓ 1-tofv <br />r ff r�119 5 iii ; I (p <br />s . - J T� c [TUnit 2 <br />2. <br />Z� <br />F- � I V6� if -Er <br />3. <br />Z"tI�7 <br />.,n-IV�,�s� <br />mm� oLv(` <br />C"2' J' 0 Unita <br />4. <br />Z <br />/L! V <br />5. <br />'Z. -t '3 (7 <br />S. Y Aj,1,q,j_) 4i V <br />No <br />,(] Unit4 <br />7. <br />Unit 5 <br />8. <br />9. <br />❑ Unit <br />10. <br />Specific Date Range of Information Requested: From Irl,S✓ /7-yrl �'Ji-CH=k' w <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />NDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACtLITYNEHIC <br />CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE j6' j~ (�P _'4 �FTHER <br />NDERGROUND TANK (MONITORINGIREMOVAL� ❑ FOOD FACILITY DAIRY ( z <br />0JABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL WASTEWATER TREATMENT PLANT <br />HAZARDOUS WASTEIHAZARDOUS MATERIALV ❑ MOTELIHOTEL 9 PUMPER TRUCKIYARDICHEMICAL TOILETS <br />TIERED PERMTRED FAGILRY�� ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING ❑ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />1. List un 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 -for additional assistance with file addresses, contact the EHD. Applications received after <br />3:00 pm will be processed the next business day. <br />2. 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 />3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br />submitted when the file is available. <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 />o..L __ a7.. -A-_ 5125 deposit prior to review. **'BOXED AREA - EHD USE ONLY"** <br />EHD 475-00 1:2 u VV W C4 141 E <br />fJ.)71 <br />