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. L1N1 L <br /> EC <br /> a <br /> SAN J(7Aau1N COUNTY <br /> ENVIRONMENTAL L HEALTH DEPARTMENT <br /> � <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)46,3-3420 Fix: (209)464-013$Web: vvww.sjgov.Or /eh <br /> N�I�U���SERVIC���� <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 6 1 <br /> APPLICANT: OLWE-V- YA BUSINESS/AGENCY: CvN'�aT"raA- S kAoc,iA-�E <br /> ADDRESS: 1pq&`t —r(zAye c`tNcf)z. DRIVr, st/rvt 10:; CITY/STATEIZIP: tZA(4CHo CCIf2Oo\/Ak'X CA <br /> PHONE(1): L'1I(,,)6b f-E98 PHONE (2):CgI(,),%"t_ RqCxp FACSIMILE, <br /> TENTAT/VE*APPOINTMENT DATE: It7-t3-1d Time: 9- <br /> (Please allow 10 business days from application submittal-"Tenfative only-must be conFirmsd) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- 122 E(CA H OR H CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map- ripti <br /> FILE ADDRESS EHD USE ONLY <br /> $ <br /> treet# Street Name City ❑Unit 1 <br /> t(�S uZN i lZtk�tLT w '5U Pf�Eµ� , ,'T K tz o P S .!,/�`��✓ <br /> 2. �3 � bbu.T Ai Q t+(ROP hh*,Tefs} ❑Unit n <br /> 3. rcrtc� S PRpMa5 TIEv+ w�'C ro.AIR R;N- wAY ArsU I(I <br /> 4. Unit 3 �J <br /> 5. <br /> 6, <br /> zult <br /> 7. <br /> $. ❑Unit 5 <br /> 10. El unit s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILiTYNEHICLE <br /> ®,OTHER CLEANUP SITE,(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ©UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUGWYARDICHEMICAL TOILETS <br /> TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONbAY-FRIDAY 5:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. IQist 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 sddreas 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 EHO 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 AHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> E14D USE ONLY <br /> r=un MSF ""-� n7f�4r1n <br />