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DATE RECEIVED EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT 4 <br />O)) ;1• 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />n�Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd , <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: MDCL-LA�N , r,),N 6,( BUSINESS/AGENCY: P?��r� �,� �� ���t3{� (rVC <br />ADDRESS: -6 S i Ems- (0c) CITY/STATE/ZIP: )-0 � L� C-4- V _0 <br />PHONE (1): �gy51vE* <br />_"V;_1-S_6-C3 PHONE (2): y_h �rj -- i6 0 FACSIMILE:�Z0-�1 <br />TENTAPPOINTMENT DATE: PCS- Time: �l <br />(Please allow 10 business days from a of appUca 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 DATE � 1_� <br />Dt <br />eu �- <br />Electronic Information: ❑ List ❑ Map - De ption: <br />FILE ADDRESS <br />EHD USE ONLY <br />f <br />Street # <br />Street Name City <br />1. <br />�q %� <br />►��- - <br />r I V�,(� �+`�-� � G �Zvt,J <br />�= fe �+I Pf �' h � t , I <br />0 <br />rU <br />O'fJnit <br />2 <br />Z-1_ <br />Fl� �if` t <br />3. <br />Z7Ir_7 <br />. <br />�21VW Pr, hq <br />ammP �} <br />U.. r.) <br />Unit3 <br />4• <br />2 <br />6. x1 V4"-7—xwo <br />5. <br />'Z -I 3 ( 7 <br />5. <br />HW -4L) 41 <br />1Jo <br />D Unit4 <br />6. <br />-Zj j <br />�, j l��v� '� 1%- .� • <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />❑ Units <br />110.1 <br />Specific Date Range of Information Requested: From lYLL /-)-V",-/ j'JA6e:,E�� to P/�J JI/T <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />[�j NDERGROUND TANK (UST) CLEANUP SITE (LOP) [:]MEDICAL WASTE FACILITY E] SOLID WASTE FACILITYNEHIC / . I <br />THER CLEANUP SITE (NON -LOP) El HOUSING ABATEMENT ❑ WASTE TIRE 10WT <br />�!� <br />UNDERGROUND TANK (MoNiTORING/REMOVAL),X, ❑ FOOD FACILITY DAIRY ( z15 <br />ZAABOVEGROUNDTANK,z>� ❑ CHICKEN RANCH/ DOG KENNEL WASTEWATER TREATMENT PLANT <br />HAZARDOUS WASTEIHAZARDOU6 MATERIAL ❑ MOTELIHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br />TIERED PERMITTED FACILITY ❑ 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 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 - 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 />daysafter receipt of application. The files will be held fora 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 />Gaitaira fila reviews by the same applicant may require a $125 deposit prior to review. °'*BOXEDAREA -EHD USE ONLY*** <br />• 1 � �_ . i� 1 � � � . A � / ilt � / 1 <br />9 _ . . - .:..iir�t+1•�i:�?..-�i=rou.�:� f�1�i1fl_�._!_--.�j% i <br />gum <br />ERB 48.46 uu LJV ) � I. <br />�j <br />CdA, <br />