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DATE REFEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> R NT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �� Telephone: (209) 468-3420 Fax. (209)464-0138 Web: www.sjgov.org/ehd OL <br /> PUBLIC RECORDS RELEASE APPLICATION �� ,�..,, <br /> APPLICANT: K-t/b ' o I ��jt/) L V trS BUSINESS/AGENCY: [' VI <br /> ADDRESS: �, �� - �j�x ���j CITYISTATE/ZIP: d.e/U ,lei . 52jIP <br /> PHONE(1): � -eLV I—3366 PHONE(2): l- 251 - 2,Lp I LP FACSIMILE: - t�7 - 2.2001 <br /> TENTATIVE*APPOINTMENT DATE:e,.,n (I I! V=G I VGS0.5,M I9 pV.j Ivl C 4M: <br /> (Please allow 10 business days from data of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE RE UST-$12 FEE{CASH CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE „2( I�� 3 <br /> Electronic Information: ❑ List❑ Map—Description: q <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name CityEl Ut*1 <br /> N����a,� <br /> 2. IGgSC) 1E. F-1 d- � <br /> , dc o )VoAbir. . +! ❑Unit 2 <br /> 3. <br /> i� <br /> 5. <br /> 6. "' 1,.� /\�� w �l'� C�T1�nit4 <br /> 7. J n l rJ <br /> 8. <br /> • 4AElUnit 5 <br /> 9. <br /> 11-0. <br /> ❑unit s <br /> Specific Date Range of Information Requested: From to <br /> 774 T74T <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACII,ITYNEHIgLE r <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT [:]WASTE TIRE ,Al 1�1OS /')t' <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)L>-•. ❑FOOD FACILITY ❑DAIRY OD- <br /> ABOVEGROUND TANK 4✓,_ ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALI`< ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ <br /> TATTOO/BODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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[east 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 /> Future file reviews by the same applicant may require a$125 deposit prior to review. *ti'B011a' 2 EIDUSE;O_NL.j! <br /> -t-.� _:. n i r.,.l a,.>' Se"(:�I !� I 1 _`J aT"*� r c � I -N-�$ �I. 3G I d aU .=•r'' <br /> "i t _1 i'. �_ l I I {�.�,�� •Ifl..'I ��..: _ 5 1. '.� I;�. ;;'� 4 � I. +I•t. '•�,;1�'-� � (;,. <br /> OW <br /> x:.• Llfi .fl ���x, a 1 ,f.;i-j a--y� - r I_ I,o _ .y ., <br /> I w. I �t�ly�.-• "!'' ' <br /> , ,'r <br /> D�Reco�ds"provided,by Staff PPR_Corrtplete stat!Name,j ' .t'� , �z, t ,.. - r 4 •4;; <br /> EHD 48-06 9/4112 <br />