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DATE RECEIVED - <br /> EHDLOC�NUMBER <br /> FAUS NTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd tj <br /> ✓- omPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Kxkfi zN)y)Suy\.. BUSINESS/AGENCY:El4Vlf_DN <br /> ADDRESS: I6)Do VDYI �p,Yfy1WA ().9 IL SW}Q. CITY/STATE/ZIP:MylYV-, CA 91wi'l,. <br /> PHONE(1): 949 -491 3to3D PHONE(2): 9y9 7A0I SISI FACSIMILE: 949 ((pl (020y <br /> TENTATIVE*APPOINTMENT DATE: 11+- aaCE(Q6jQ -(?,b Time: <br /> (Please allow 10 business days from date of application submittal-•Tentafive only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUJ=ST- 125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 012-4111— <br /> Electronic information: ❑List❑Map- escription: <br /> FILE ADDRESS EHD USE ONLY <br /> V, Street# Street Name __City <br /> �(� 1 OD t�L Si SfiiCt li unttl <br /> 2. f <br /> RJ2 3 nIt 2 <br /> 4. `��� <br /> S. unit s <br /> 8. <br /> 7 Unit 4 <br /> 8. <br /> 9 unit 5 <br /> 10. <br /> UnH 6 <br /> Specific Date Range of information Requested: From Al� to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®.UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACIL211PLANT <br /> HICL <br /> [+OTHER CLEANUP SITE(NON-LOP) .®FOOD FACILITY WASTE TIRE /- ( (UNDERGROUND TANK(MONITORINGIREMOVAL� ❑DOG KENNEL '®DAIRY <br /> HAZARDOUS WASTE GENERATORV ❑CHICKEN RANCH LN TIERED PERMITTED FACILITY o` ❑MOTECfl10TEL ®'WASTEWA <br /> ❑TATTOOIBODY PIERCING ❑PO TELMOLISPA M-PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> Q MEDICAL WASTE FACILITY LAND USE APPLICATION SITES <br /> ®.COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(ExcLUDINe HOLIDAYS) <br /> 1. List uo to ten addresses In the space above. Select the type(s)of£les from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 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. <br /> EHD USE ONLY <br /> EHD 4a-08 <br /> rnitt <br />