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DA,F�CE)V�D• -*=z" >•- EHD LOG NUMBER <br /> = '-; / w= SAN JOAQUIN COUNTY <br /> )UL. v 1(113 ENVIRONMENTAL HEALTH DEPARTMENT /� { <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 r/\ <br /> FN4l, ,Pfrs,: f t�el� cane:(209)468=3420 Fax: (209) 464=0138"Web;wwwsjgov.org/ehd "J) <br /> PUBLIC RECORDS RELEASE APPLICATION r —r <br /> APPLICANT:��p(Syl-er q Akal cc BUSINESS/AGENCY: E-CDZ, Jv\B <br /> � �— <br /> ADDRESS: t l S S1� I c, C,/q ¢A CITY/STATE/ZIP: Sa-%, Qrf gyca f <br /> PHONE (1) &-)q S46 -,5'?- S?_ PHONE (2): FACSIMILE: <br /> TE TATIVE*APPOINTMENTDATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> [—] CHECK BOX TO EXPEDITE RE T- 125 FEE(CA C ECK Y)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT C DATE X75 sk I h 13 <br /> Electronic information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 1/ <br /> Street# {Street Name t� City ❑ Unit 1 <br /> tl 1 t�C:CJ vL wt4 1r- L . ( YYI tNO cDr <br /> U z. Sou wtah �Z Lod 41 W — yP <br /> 3. <br /> 4. <br /> Unit 3 <br /> 5. � <br /> 6. `t��//((// <br /> Unit4 ( tS <br /> 7. <br /> 8. <br /> ❑unit s <br /> 9. <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> FTdNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY KS—OLID WASTE FACILITYNEyICLE <br /> F36OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE j 61 t;:i i-t.t./I I I�" <br /> NDERGROUND TANK(MONITORINGIREMOVAL)i ❑FOOD FACILITY ❑DAIRY "3 <br /> LQABOVEGROUND TANK V- ❑CHICKEN RANCH/DOG KENNEL ASTEINATER TREATMENT PLANT <br /> HAZARDOUS WASTE/HAZARDOUS MATERIALS Q'C ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOL/SPA ❑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 /> 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 `^` <br /> � to review_ *"BOXED AREA-EHD USE ONLY <br /> A-13'• " l cog Ft <br /> 50 R-4PJuv <br /> 0 3314q iDl2 <br /> ❑ Reco ds provided by Staff-PPR Complete. Staff Name: <br /> EHe 48-DB <br /> 914112 <br />