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DATE RECEIVED �Q�O 'ON NVCI :6 ZI0 nr:lmil paAl ;);� <br /> SAN .10AQUIN COUIV t Y <br /> RECEIVED <br /> s: <br /> ENVIRONMENTAL HEALTH DEPARTirItNT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> JUL I $ ZQ1Z Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVI RMMES AL HEA TH <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: M ,.1� �Q s �/�n BUSINESS/AGENCY: /(/e/// <br /> Siv-, <br /> (�n✓, Il�h/�'+P,.�f <br /> ADDRESS: X45-01 PG�� %5� ZY CITYISTATE/ZIP: 11100PS-}y <br /> PHONE(1): AoJ—76�-_7q&D PHONE(2)- FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: J'ul Time: /o:vc? 4,r, <br /> (Please allow 10 business days from date of plicaion submittal-`Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$12 EE(C CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT GDATE`/ <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City it 1 <br /> F -3/05- ! Geri J`. 5T <br /> � <br /> 2. S _._ Unit 2 <br /> 3. <br /> 4. / <br /> ,�Unit <br /> 5. <br /> 6. � D'fJnit 4 <br /> .!' <br /> 7. <br /> 8. ❑Unita <br /> 9. j <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested_ From 7 to ✓PS .�, <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT []SOLID WASTEF�1CI i YNEHIC,LEE t3. <br /> ER'OTHERCLEAN UP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINWREMOVAL),9 -- ❑DOG KENNEL ❑DAIRY <br /> TRHAZARDOUS WASTE GENERATORd-. ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> &'TIERED PERMITTEDFACILITYZ,/— ❑MOTEUHOTEL ❑PUMPERTRUCK(YARDICHEMICALTOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ©COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERN9T RECORDS ARE AVAELABLE 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 /> days after receipt of application. The Cle%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 fn 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$125 deposit prior to review. <br /> a/rt <br /> EHD 48.06 61/11 <br /> ■ I <br /> L'd I•ZZZL9£60Z UosleN 13ZZ:60 Z1, 12 1, I�I <br />